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UNC-CH HEALTH SCIENCES LIBRARY
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This Bulletin, will be servt free to any citizen of the State upon request I
Entered an- second-class matter at Posioffiee at Raleigh, N. C, under Act of July 16, 18Q4.
Published monthly at the of/ire of the Secretary of the Board, Raleigh, N. C.
Vol. 55 JANUARY, 1940 No. 1
HEALTH OFFICERS TO BE TRAINED HERE
New Medical-Public Health Building was opened at the University of
North Carolina, Chapel Hill, December 4, 1939. A distinguished
pQarray of notables participated in all-day and evening exercises, under
\pthe general supervision of Dr. W. deB. MacNider, Dean of the
f\iMedical School, assisted by Dr. Milton J. Rosenau, Director of the
-0 School of Public Health, and other members of the faculty.
r—
l^ Photograph courtesy Mr. R. W. Madry, Chapel Hill.
V
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
S. D. Craig, M.D., President _ _.„ Winston-Salem
J. N. Johnson, D.D.S., Vice-President Goldsboro
G.G.Dixon, M.D __ _.Ayden
H. Lee Large, M.D „ „ _ Rocky Mount
H. G. Baity, ScD _ _....ChapeJ Hill
W. T. Rainey, M.D _.Fayetteville
Hubert B. Haywood, M.D _ Raleigh
J. LaBruce Ward, M.D Asheville
C. C. Fopdham, Jr., Ph.G.._ _ Greensboro
Executive Staff
Carl V. Reynolds, M.D., Secretary and State Health Officer.
G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Health
Education, Crippled Children's Work, and Maternal and Child Health Service.
Warren H. Booker, C.E., Director Division of Sanitary Engineering and Malaria
Control.
Ernest A. Branch, D.D.S., Director Division of Oral Hygiene.
John H. Hamilton, M.D., Director Division of Laboratories.
J. C. Knox, M.D., Director Division of Epidemiology and Venereal Disease Control.
R. T. Stimpson, M.D., Director Division of Vital Statistics.
R. E. Fox, M.D., Director Division of County Health Work.
T. F. Vestal, M.D., Director Division of Industrial Hygiene.
FREE HEALTH LITERATURE
The State Board of Health publishes monthly THE HEALTH BUL-LETIN,
which will be sent free to any citizen requesting it. The Board
also has available for distribution without charge special literature on the
following subjects. Ask for any in which you may be interested.
Adenoids and Tonsils
Appendicitis
CaDcer
Constipation
Chicken pox
Diabetes
Diphtheria
Don't Spit Placards
Eyes
Flies
Fly Placards
German Measles
Health Education
Hookworm Disease
Infantile Paralysis
Influenza
Malaria
Measles
Pellagra
Residential Sewage
Disposal Plants
Sanitary Privies
Scarlet Fever
Smallpox
Teeth
Tuberculosis
Tuberculosis Placards
Typhoid Fever
Typhoid Placards
Venereal Diseases
Vitamins
Water Supplies
Whooping Cough
SPECIAL LITERATURE ON MATERNITY AND INFANCY
The following special literature on the subjects listed below will be sent
free to any citizen of the State on request to the State Board of Health,
Raleigh, N. C.
Prenatal Care
Prenatal Letters (series of nine
monthly letters)
The Expectant Mother
Breast Feeding
Infant Care. The Prevention of
Infantile Diarrhea.
Table of Heights and Weights
Baby's Daily Time Cards: Under 5 months;
5 to 6 months; 7, 8, and 9 months; 10,
11, and 12 months; 1 year to 19 months;
19 months to 2 years.
Diet List: 9 to 12 months; 12 to 15 months;
15 to 24 months; 2 to 3 years: 3 to
6 years.
Instructions for North Carolina Midwives.
CONTENTS
Notes and Comment Page 3
Opening New Medical School Building, University of North Carolina,
Chapel Hill Page 6
Greetings By Carl V. Reynolds, M.D Page 6
Greetings By William Allan, M. D Page 6
Fifty Years in the Medical School By I. H. Manning, M. D Page 7
A Conception of a School Health Education Program Page 8
Diphtheria Riding High Page 9
Heart Disease Page 10
Health Problems of the Child Page 11
Dr. Hall Memorializes Doctors Whitehead and Mangum Page 14
Mrs. Doak Explains the Humbug Business Page 15
Legal Notice Page 16
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PU5LI5ME1D BY THL P1QR.TM CAROLINA 5TATE- B°AI?D s^MEALTM
Vol. 55 JANUARY, 1940 No. 1
Notes and Comment
By The Editor
HUMBUGS—Series Continued
/^\NE of the most remunerative rack- ^ ets carried on in North Carolina
for a great many years by hum-bugs
and fakers of every descrip-tion
has been in the exploitation of
people who have some form of eye
trouble or visual defect. A most
systematic racket carried on from
year to year has persisted for more
than twenty years. Evidently, the
group who have made this busi-ness
pay them so well are affiliated
and work together. It is probable
that this racket is largely carried
on by a bunch of crooks who have
a central organization directing their
activities. There is one thing that
has been noted in all these years
about the methods carried on, and
that is that a fictitious name is used
or a fictitious address is always
given.
The latest report on this bunch of
humbugs is sent up by Dr. W. N.
McKenzie, the alert young health of-ficer
of Stanly County. Dr. McKen-zie
surely does not object to our pub-lishing
his letter, which follows:
"Do you have any information
about a Mr. G. L. Law, who travels
through the country selling glasses
to those persons who are not intel-ligent
enough to realize that eye
examination is the most essential
part in the purchase of glasses ? This
man has sold several pairs of glasses
in the western part of Stanly County,
and just recently we contacted a child
to whom he had sold glasses; it was
positively impossible for this child
to walk with the glasses on. In my
opinion, this is one of the worst
things we could have existing, and
I would appreciate any help which
you might give me regarding this
matter. I might mention that Mr.
Law told these people that he lived
in Charlotte, N. C., and that he
was listed in the telephone directory,
but it was impossible to find any such
person listed in the City Directory
for Charlotte."
It will be noted by reading Dr.
McKenzie's letter above that this
quack was operating in the approved
manner, in that he gave a fictitious
address. Many years ago two of the
most successful fakers that operated
by claiming to be "eye doctors" gave
an address on Fayetteville Street in
Raleigh as the location of their of-fices
on which the present City Audi-torium
now stands. Of course, there
was not an office or a residence on
that block. This man in Stanly, of
course, is playing a little safer.
Knowing that no one in Stanly
County would have a telephone di-rectory
of Charlotte, he could not
be checked on right that minute.
People will simply have to learn
that when someone comes along to
try to sell them something good for
their health, either medicine, based
on a diagnosis on the spot, glasses
or anything of the kind, that they are
100 per cent fakers and humbugs.
No reputable physician and no com-petent
authority in the field of medi-cine
is going out and promiscuously
The Health Bulletin January, 1940
undertake to sell eye-glasses, make
diagnosis of disease and prescribe and
sell so-called medicine for any par-ticular
ailment, and therefore such
agents or so-called "doctors" should
be immediately reported to the county
Sheriff or the police.
* * * *
We are pleased to publish two or
three of the papers presented at the
dedication of the new medical build-ing
at the University of North Caro-lina,
which took place on December
4th. This building is known as the
Medical and Public Health Adminis-tration
Building of the State Uni-versity.
Its erection and the pro-vision
for the establishment of the
competent school of public health
administration at the University
marks, in the opinion of the Editor,
one of the most important steps in
the progress of the University
throughout its whole history. The
need in this section of the South has
been long felt for a high-grade
school of public health administra-tion.
Only one thing is now lack-ing,
and that is a school for the
training of public health nurses to
be established in connection with this
school or at some of the other high-grade
institutions of learning in
North Carolina. We hope that be-fore
another year passes that such
a provision will have been made.
* * * *
The Editor was invited down to
the meeting of the Southern Medical
Association in Memphis, Tenn., the
latter part of November to discuss
a paper presented by Mr. John M.
Oibson, Director of the Division of
Public Health Education in the Ala-bama
State Department of Health.
Mr. Gibson is a native of Scotland
County, North Carolina, and a gradu-ate
of the State University. For
several years he was Editor of the
Sanatorium Sun, the official publi-cation
of the North Carolina Sana-torium
for Tuberculosis. He made
a distinguished record in that work
and made that publication notable
for the interest and information con-tained
in each issue. More than two
years ago Mr. Gibson was made Di-rector
of the Division of Public
Health Education in the Alabama
State Board of Health and is doing
a very satisfactory piece of work in
that State.
The title of Mr. Gibson's paper
was "Publicity's Place in the Public
Health Program." In Mr. Gibson's
paper he emphasized the fact that
his work in Alabama was devoted
mainly to efforts through the two
now well-established publicity media,
that is, the press and the radio. Mr.
Gibson was inclined to emphasize the
very important place that the printed
word still holds in the dissemination
of information. The Editor of the
Health Bulletin agrees fully with Mr.
Gibson in that opinion. When infor-mation
is properly printed, it may
be read and studied and re-read,
whereas a talk over the radio must
be caught instantly or it is gone.
A speech before an audience has its
disadvantages. Sometimes it is hard
to understand passing statements and
misinterpretation is much more evi-dent.
The State Board of Health makes
an endeavor to utilize all of these
media, but up to now its main de-pendence
is the printed word. Mr.
Gibson made one statement that is
so interesting and so true that we
want to pass it along, to-wit: "I
once knew a successful soft drink-bottler
in Brooklyn who used to say:
'Whenever your bottling plant smells
like a bottling plant, it's time to clean
it up.' That gentleman's observation
might be paraphrased to say: 'When-ever
your health talk sounds very
much like a health talk, you'd better
January, 191,0 The Health Bulletin
"e-write it'." This is sound sense.
Another statement that Mr. Gibson
made which we would like to pass
along to all of our workers in public
health in North Carolina is this:
"The public health worker is never
off duty." When he made that state-ment
in his speech in Memphis, the
Editor could not help but think of
the sanitary engineer over in the
Health Department in Dare County,
North Carolina, who recently took
the trouble to write to the Governor,
protesting his having a photograph
made showing the Governor partak-ing
of his favorite cold drink in a
common drinking-glass, when just
back of the Governor's head and
showing in the picture was a stack
of sterile paper cups. The point is
this, that this sanitary inspector, be-ing
fully aware of the dangers of
promiscuous use not only at drink
stands but in restaurants and other
public places of common drinking-cups
or drinking-glasses, when not
completely sterilized after each ser-vice
was alert to the opportunity
for <pressing his regret that the
Govcnor did not think of the ex-ample
he was setting. Naturally,
in the drug store that the Governor
was being served there was possibly
no question of the sanitary facilities
and the safety of their drink service,
but such is not the case by any means
in all places in the State where
people partake of their favorite foods
and drink. In other words, the
sanitary engineer of Dare County is
on his job twenty-four hours a day,
seven days in the week, which is well
for Dare County.
We were pleased to renew contact
with Mr. Gibson and congratulate the
State of Alabama on having the
services of such a competent man
in its organization.
As Director of the Maternal and
Child Health Service of the State
Board of Health, it was a great privi-lege
of the Editor sometime ago to
attend one of the well baby con-ferences
or clinics in Anson County
conducted by Dr. Wallin, the County
Health Officer. This particular clinic
was being held that morning in an
old church in one of the small towns
of the county. The church has been
reduced in membership until it is
almost ready to be abandoned, but
the half-dozen faithful remaining
members suggested to Dr. Wallin
that when the school opened and the
schoolhouse was no longer available
for this work once a month that
the church be opened and made avail-able.
At the time of the Editor's visit,
the church auditorium was about half
full of mothers with their babies.
This clinic was for white women
having no private physicians, and
although Anson County has one of
the lowest infant death rates of any
county in North Carolina, the death
rate being several points below the
national average and at least twenty,
points below the North Carolina av-erage,
Dr. Wallin believes in bring-ing
it still lower through intensive
work of this character.
The Editor has never witnessed a
more thorough and careful examina-tion
by any clinician or private phy-sician
anywhere than Dr. Wallin was
doing for these babies of the poor
folks of that county. It was an in-spiration
which we needed and which
we will not soon forget. We hope
that the work in Anson County and
in all other counties in the State may
increase this year to a greater ex-tent
than ever before.
The Health Bulletin January, 19UO
Opening New Medical School Building, University
of North Carolina, Chapel Hill
GREETINGS
By Carl V. Reynolds, M. D.
State Health Officer
Since the birth of the Medical
School of the University of North
Carolina, the members of the cura-tive
branch of medicine have watched
with justified and increasing pride
its continued growth and the perma-nent
place its professors and gradu-ates
have taken in the march of medi-cal
progress.
Today, the State Board of Health
is thrilled to rejoicing that the pre-ventive
branch of medicine has found
a place, and is now well-established
as a growing institution, within the
walls of this new medical building
situated on the traditional campus
of the University of North Carolina.
Curative medicine is necessarily in-dividualistic
in thought and admin-istration.
Preventive medicine is collectivistic
in thought and administration.
The two branches are didactically
and idealistically the same, and are
so interwoven and interlocking that
the success or failure of one means
the success or failure of the other.
This is the time and place to frater-nize
the two schools of thought and
make this new era "serve us rather
than enslave us."
Never before did we need, as we
do now, intelligent leadership. The
basic element of any successful en-deavor
is a sound organization car-rying
forward intelligently and con-scientiously
the issue presented, hav-ing
always in mind service before
self.
In this building, being dedicated
today, we have the two schools of
thought.
What a grand opportunity it is
to bind this misunderstood problem
into a unity of thought and action
and set about to watch, plan, guide
and direct all medical activities in
a channel that will protect our noble
heritage and better serve the funda-mental
changes that are being made
and are necessary to more adequately
meet the needs of humanity.
The greatest asset in any State
lies in the efficiency of the moral,
mental and physical development of
her womanhood and manhood.
Greetings to the University that
will be the first to unify the two
schools of thought and bring forth
a happy solution to this perplexing
problem.
GREETINGS
By William Allan, M. D.
President, North Carolina Medical Society
The majority of the medical men
in North Carolina got their best
training on this campus. They were
trained by the medical faculty that
is still here, with the addition of the
beloved Dr. Mangum. Even a Tar
Heel by adoption knows what has
been known to everybody in the
State for years, that while our young
men were enrolled in the medical
school they learned from close per-sonal
association with this faculty
January, 19U0 The Health Bulletin
those lessons of honesty and industry
and patience and high ideals that are
worth infinitely more than any techni-cal
knowledge of medicine.
During the past thirty years I
have witnessed a wonderful improve-ment
in the quality of medicine prac-ticed
in this State, and I think this
medical faculty largely responsible.
So, it is with sincere pleasure that as
the representative of the State Medi-cal
Society, whose usefulness depends
so directly on your activities here, I
bring greetings and best wishes, Dr.
Graham, to the medical faculty. We
are as pleased as possible at your
new home, and may you live long
and prosper.
FIFTY YEARS IN THE MEDICAL SCHOOL
By I. H. Manning, M. D.
Former Dean at University of North Carolina Medical School
Mr. House, Dean MacNider, Ladies
and Gentlemen:
To those of us who have had an
intimate knowledge of the Medical
School since its beginning, the open-ing
of this building, spacious and
splendidly equipped, is the realization
of a dream—perhaps I should say a
reward for many years of labor. It
is an occasion for rejoicing, of look-ing
forward, of planning for the
realization of the high hope all of
us have.
The temptation to look backward
to its beginnings is, however, ir-resistable,
and it may be profitable
to examine the foundations, not only
to find justification for this venture
to higher levels, but "to learn those
things of good repute" to which we
should hold fast and find courage
in them.
During the first decade, from 1890-
1900, we recall the one lecture room
in the middle entrance of the Old
West Building, the partition between
two bedrooms having been removed,
and the one-story 14x16 frame build-ing,
dignified as the Dissecting Hall,
so unsightly and unsavory that it
was camouflaged in the rear of the
campus and only the initiated could
find it. But within these crude rooms
was Dr. Whitehead, a master teacher,
stimulating, inspiring, genial, lov-able,
and under the spell of his splen-did
personality the students were ob-livious
of their surroundings. We
recall his restless pacing across the
floor as he lectured, or the inces-sant
rocking as he sat in his office,
the informality of his relations with
his students, whether in the class-room
or out, all of which added to
his charm and won their affection, as
his profound knowledge of his sub-ject,
the clarity and conciseness of
his lectures, won their admiration and
confidence.
Dr. Whitehead was assisted by
Dr. H. V. Wilson, painstaking, ex-acting,
kindly but peppery, who initi-ated
the medical students into the
mysteries of microscopic anatomy;
a real, genuine friend as ever a
student had.
The response of the students to
these two gifted teachers and un-usual
personalities was genuine, per-sistent,
enthusiastic work, not eight
hours, but sixteen hours a day, and
seven days a week. No student
could face them without having done
his best, not from fear of caustic,
humiliating criticism, but for the love
of following such leadership. Work
—
honest, indefatigable, became a tra-dition
in the Medical School—a tra-dition
that has been recognized
everywhere on the campus and has
been a real contribution to its life.
This has compensated for the lack
of men, money and equipment and
accounts for the success of the stud-
8 The Health Bulletin January, 194-0
ents in the schools and in after-life,
which has come in no small measure.
This is the foundation upon which
this school has been built; it is an
invaluable legacy.
Since 1900, medical science and
medical education have made revolu-tionary
progress and millions of dol-lars
have been spent on medical
schools and hospitals. The practice
of medicine now demands the highest
technical skill and interpretative
intelligence. The entrance require-ments
have advanced from a high
school to three, practically four, years
of college. The medical curriculum
has been extended from three to four
years and one or more years in a
first-grade hospital. The four years
of the medical course are crowded
with new and subdivisions of old
subjects, all definitely on the gradu-ate
level. With all of this marvel-ous
advance, this school has kept the
pace, a fact recognized and accepted
by all of the medical schools from
McGill to Tulane. Our students have
held their own in the keen compe-tition
for school honors, in the ap-pointments
for hospital service, and
finally in the general and special
practice wherever they have gone.
In these facts may be found full jus-tification
for this venture into broader
fields.
The emphasis has obviously been
placed on the teaching and training
of doctors. I assume that the time
has now arrived when the school will
take its place in the field of research
and the third chapter in its history
will be written. To its success I
bring the good wishes of a thousand
loyal alumni.
A Conception of a School Health Education
Program
By Dr. D. F. Smiley*
IF the present were the relatively
simple civilization of the early
Greeks, our schooling might well con-sist
of philosophy to teach us how
to think and physical training. Mod-ern
civilization has, however, long
since outmoded this simple system
of education. We still try to teach
children how to think, but we have
also added numerous factual and vo-cational
courses. We still too often
continue to use the "physical train-ing
approach," forgetting (1) that
in modern life physical development
per se is not nearly as important
as sound health habits, sound health
knowledge, sound health attitudes
and sound methods of health main-tenance;
(2) that physical training
is only a small part of what school
physicians, dentists, nurses, physical
educators and specially trained health
teachers can provide to protect and
promote the health of school chil-dren.
What is most needed in our
public schools is a preventive medi-cal
program built along lines of the
six-point public health program of
our city health departments, i. e.,
communicable disease control meas-ures,
sanitation, child hygiene meas-ures,
vital statistics, public health
laboratory services, health education.
Assuming that this goal was adopted,
what would be the essential steps in
approaching it? I would suggest five
steps:
1. Develop short training courses,
which will prepare school physicians
to attack the health problems intelli-gently
and on the preventive medical
basis
2. Omitted.
January, 19J,0 The Health Bulletin
3. Develop among the medical pro-fession
the following conceptions of
school medical service: (a) It is
not a treatment service; (b) it is not
expected to provide each child with
a meticulous medical examination an-nually
(that is the parents' responsi-bility
and family physician's func-tion);
(c) it is expected to provide
a continuous health supervisory ser-vice
based on the continuous screen-ing
by the classroom teachers; (d)
it is expected to provide certain
group tests, and (e) if properly or-ganized
it can be made a high-grade
preventive medical service to which
any doctor can be proud to con-tribute
through a lifetime of service.
4. Train all elementary teachers
in the observation of the child's phy-sical
condition and in the elements
of health instruction suitable to his
age.
5. Develop at our universities spe-cial
training courses for health teach-ers
who will superimpose on a foun-dation
of science courses and pro-fessional
education courses a course
in health education which will pre-pare
them (a) to present ade-quately
to high school pupils the
facts of modern preventive medicine,
and (b) to keep their health knowl-edge
abreast of the many changes
and additions that are being made
to health knowledge from month to
month.
Reprinted, by permission, from the Jour-nal
of the American Medical Association,
Vol. 109, No. 11, September 11, 1937.
DIPHTHERIA RIDING HIGH
Just as we go to press, we are
reminded from several sources in dif-ferent
sections of the State that al-though
a law requiring immuniza-tion
of all babies under twelve months
of age against diphtheria was enacted
on March 17th, last year, diphtheria
is prevalent all throughout the State.
The law is not being complied with
and children are having diphtheria
and dying.
We received recently the following
letter from Dr. Wilburt C. Davison,
Dean of the Duke Medical School:
"Can anything: be done through the
State Board of Health or through
the County Boards of Health in re-gard
to the appalling number of
cases of diphtheria we are having
this year? I enclose a list of twenty-eight
patients we have had in the
last ninety days. Twenty-two of
them were between the ages of six
months and five years, in which, ac-cording
to the law, they should have
been immunized. Nine of them re-quired
tracheotomy and three of
them died."
At the bottom of Dr. Davison's
letter he stated that since the above
letter was dictated that morning an-other
diphtheria patient had been ad-mitted
to Duke Hospital.
On the night before this letter was
received, Dr. A. S. Root, a Raleigh
pediatrician, informed the Editor that
the week before he and his partner
had five cases of diphtheria referred
to them from one family in Wake
County. Dr. Root stated that in his
practice cases of diphtheria were
coming from the country districts,
some of them in remote farming sec-tions,
and not one of them had heard
of the law being passed and none
of them knew about the protection
afforded through immunization.
Both Doctors Davison and Root
and many other practicing physic-ians
in the State insist that more
publicity must be given about the
requirements of the law, more in-formation
must be disseminated and
it must be carried to the sections
of the State where it is needed. All
of them claim that there is no way
in the world that this can be done
except through the efforts of practic-ing
physicians. With just a little
extra trouble, the physicians can ex-plain
to their patients when making
calls in families having children, and
in their offices, that the law requires
immunization and that when a baby
is properly immunized with at least
two doses of toxoid, a potent pro-duct
properly safeguarded and ef-ficiently
administered, that such a
child will probably be protected from
then on against diphtheria.
10 The Health Bulletin January, 1940
The columns of the Health Bulletin
have carried information almost every
month during the past few years
about the diphtheria problem and
offering suggestions as to how it
may be eliminated. The Health Bul-letin
can do no more than it has
been doing, and it is hoped that ex-tension
of information on the sub-ject
will be extended in such a man-ner
that this time next year no
child may be living in the State who
has not had the protection of im-munization.
The law puts the burden of execu-tion
on the parent, but when parents
in hundreds and even thousands of
cases in the State do not even know
about the law, let alone the possi-bility
of protection through immuni-zation,
the first step will naturally
be to get such people informed.
Heart Disease
Serial Health Letter Published in Bertie and Chowan Papers
By F. H. Garriss, M. D., District Health Officer
]\ /IORE people per thousand die of
AV '* heart disease today than did
twenty-five years ago. The death
rate for all other diseases has de-creased
during this period of time,
but not so with heart disease. It has
increased. Why? Don't the doc-tors
know as much about this human
ailment as they did twenty-five years
ago ? They do and a great deal
more. Aren't the public health work-ers
of the country trying to prevent
deaths from this cause as they are
from other causes? Yes, they are
doing their best to prevent the dis-eases
and defects that cause heart
trouble.
To begin with, heart disease is
hardly ever primary, it is generally
secondary to some other disease or
defective condition. It is of several
different types. The muscles of the
heart may be diseased and prevent
the organ from contracting properly.
The valves may be diseased and not
open wide enough or close tight
enough. In the first case, if the
valve does not close properly, part
of the blood that is pumped out will
leak back into the heart with each
pulsation or contraction of the heart.
And also the nerves that go to the
heart may be at fault, causing missed
or irregular contraction. All of these
conditions cause the same symptoms,
namely: Pain, shortness of breath
and easy to tire.
What causes heart disease? A
very few people are born with de-fective
hearts. The chief causes of
this defect are: The childhood dis-eases,
diseased tonsils, any acute in-fectious
disease, any septic infection,
syphilis, alcoholism, indiscreet eat-ing
and certain slow mineral poisons.
Of the childhood diseases, whooping
cough heads the list and especially
if the child has it before he is three
years of age. The next in order is
measles. We once were afraid of
diphtheria and scarlet fever, but
diphtheria is easily controlled and
scarlet fever is very rare now and
is also very mild. Whooping cough
kills more children than any other
childhood disease, and when it doesn't
kill, it often leaves the heart dam-aged
so that the patient develops
heart disease after he is grown.
Infected or diseased tonsils are the
next greatest offenders. A large
healthy tonsil is harmless, but the
small ragged or cryptic tonsil that
one can mash pus out of is one of
the most dangerous things in a child's
body. In my recent examination of
January, 19J+0 The Health Bulletin 11
over a thousand high school athletes
I found diseased tonsils associated
with over 75 per cent of the cases
with bad hearts. The infective ma-terial
in the tonsil is carried by the
blood to the heart muscle and valves,
where it sets up an infection that
lames the heart for life if it doesn't
kill in a few years.
Of the infectious diseases several
can be named, such as pneumonia,
typhoid fever and smallpox, but the
worst of all is acute rheumatic fever.
Thanks to our position under the
sun, we do not have much of this
disease in North Carolina. It is most
prevalent in colder States. Sunshine
is the cure for this dreaded disease.
Of the septic infections, we have
diseased tooth sockets, ear trouble,
pyelitis and ordinary abcesses, but
erysipelas is by far the worst.
Syphilis in a large percentage of
its victims attacks the muscle and
lining of the heart and large blood
vessels. These people generally die
suddenly before they are fifty years
of age. Alcoholism and indiscreet
eating generally cause disease of the
muscle of the heart as secondary to
liver disease.
But why is the death rate from
this disease higher today than it
was twenty-five years ago, while at
the same time we are doing all we
can to reduce it? It will be, pos-sibly
during the next generation, that
the death rate will decrease. Why?
Because we are today dealing with
hearts that were damaged over
twenty-five years ago, when people
were careless about the health of
their children; when every mother
thought her child should have measles
and whooping cough as soon as pos-sible
and get it over with; when
people thought tonsils were put in
the throat for a purpose and thereby
should stay there. Healthy tonsils,
like a healthy appendix, should be
let alone, but diseased tonsils are
just as dangerous as a diseased ap-pendix
and should come out. Re-member,
heart disease starts during
childhood and kills during active
adult life.
Another reason the death rate is
increasing is because we are trying
to live a 1930-1940 life with an
1890-1900 heart. Those last century
hearts were not intended, even
if not diseased, to stand the rapid
and strenuous grind of 1930-1940.
That's why, today, the health work-ers
of America are paying so much
attention to the physical training of
school children. We are doing every-thing
we can to prevent childhood
diseases, to remove diseased tonsils
and to teach the parents and children,
too, how young bodies should be fed
and trained, so that when they are
grown they will have healthy bodies
and strong hearts that will be capable
of withstanding the requirements of
the next generation.
Parents, we ask you to please help
us to protect the hearts of your
children.
Health Problems of the Child
By Roy Norton, M. D., Professor of Public Health Administration
Division of Public Health, University of North Carolina
IN a consideration of the health
problem for the child, we cannot
escape the fact that child health is
closely tied up with family health,
and that family health problems are
forever inseparable from social, eco-nomic,
educational and ethical fac-tors.
Food, transportation, clothing,
housing and environmental sanitation
of the family and the community are
12 The Health Bulletin January, 1940
vital concerns in any program of
child health protection and promo-tion.
Even after providing all these
essentials, there yet remains the de-velopment
of adjustments, adapta-tion,
balance. The importance of the
physical well-being of the mother in
creating a healthful home environ-ment,
of the father in providing eco-nomic
family needs, and of both in
the maintenance of ethical standards
cannot be overestimated. Child health,
family health and community health
progress or lag together. So also
the physical, mental and spiritual
well-being of the child are either pro-moted
together or hindered together.
We like to think of the child just as
we think of the grownup, as an inde-pendent
and free individual; yet each
influences, and is influenced by, out-side
forces from the cradle to the
grave.
Most of the improvement that has
been made in our general mortality
statistics and in life expectancy has
been brought about by efforts aimed
at improving child health through
preventing infections and improving
nutrition. To appreciate the vital in-fluence
of this health care for the
child we have only to consider that
during the lifetime of some of us
life expectancy at birth has been
raised from forty to sixty years,
even though the expectancy of per-sons
of fifty or sixty has not been
appreciably altered. Interestingly
enough, having seen what previous
efforts have done in raising the stand-ards
of general health and longevity,
more and more attention has gradu-ally
been shifting toward earlier
stages in the individual's existence.
From the school child we have turned
to the pre-school age period, then
to the infant, to the post-natal, ob-stetric
and pre-natal care of the
mother, and more recently, even to
the pre-conception and pre-marital
hygiene of both parents. Perhaps
eventually we may get around to a
fuller appreciation of heredity as
well as environment. Just as we
find the adult of today influenced by
the child of yesterday, we know that
parental health today means child
health tomorrow. Perhaps we may
reasonably expect from these efforts
as dramatic and as fundamental pro-gress
in human health and welfare
as were realized from the early health
work directed specifically for the
growing child.
One of the most pressing problems
in child health at present is bridg-ing
the gap between the accumulation
of medical and health information on
the one hand and bringing about the
general practical application of this
knowledge on the other. No one
questions the vital importance of,
and no one would delay progress in,
providing facilities for adequate and
available medical and health care for
children, even though we may not
all agree on methods or the order
of their importance. Research must
continue to show the way. The need
for health education, however, is per-haps
the most pressing among our
Southern child health problems.
When, for instance, we find one-fifth
of the pediatric deaths in a State
occurring among children who are
not taken to physicians, that is not
prima facie evidence of the absence
of medical care due to poverty and
the lack of medical resources. Fami-lies
in all economic and social groups-are
failing to properly avail them-selves
of trained personnel and medi-cal
facilities. Fourteen per cent of
medical costs is largely wasted since
this amount is spent on patent and
home medicines, which are used pro-miscuously.
That teaching the public to uti-lize
present medical facilities is a good
investment is well illustrated by a re-
January, UtAO The Health Bulletin 13
cent study of the medical care being
received by a group of adults among
whom information regarding cancer
has been made available. Eighty per
cent of those with general chronic
diseases failed to obtain medical care
through ignorance and the need of
education, and 10 per cent through
economic reasons, while only 37.4 per
cent of cancer patients went without
medical care through ignorance and
only 1.5 per cent for economic rea-sons.
Great progress has been made by
directing health efforts, especially
health education, toward the improve-ment
of environmental sanitation and
against common communicable dis-eases
of children. The work of the
future will be aimed more and more
toward getting us all to make greater
use of individual intelligence with
regard to matters of personal hy-giene.
We are still, however, far
from completing our first program
of environmental sanitation, which
is of the utmost importance in our
Southern States, where soil condi-tions,
climate and insect prevalence
combine to complicate our problem by
special hazards from malaria, hook-worm
and typhus, not to even men-tion
other vital factors covered by
other speakers on this program.
Perhaps in no realm of human
thought do we find more misinforma-tion
and misconceptions than we do
in matters relating to child health.
Considerable progress has been made,
but even today commercial exploiters
are allowed to take advantage of
human ignorance and misery. In
spite of improvements in surgical
technic and general hospital treat-ment
facilities, appendicitis deaths
are failing to decrease largely be-cause
of the delay and the giving
of cathartics encouraged by those who
are making money from the manu-facture
and sale of laxative drugs.
This is cited merely as an illustra-tion
of several similar health prob-lems.
Do we have a responsibility
in such matters?
Some of you are perhaps wonder-ing
just how important some of these
prevalent misconceptions may be.
Most of you have heard mothers and
even school teachers say: "It is best
for a child to have these contagious
childhood diseases early and be
through with them before starting
to school." This sounds like a
very practical and perhaps sensible
thought, yet few more valuable things
could be done within the next few
years to cut down deaths of chil-dren
than eradicating this danger-ous
misconception and putting in its
place a positive determination to post-pone
as long as possible a child's
having any disease. An analysis of
North Carolina statistics from 1934
through 1938 shows that an almost
miraculous reduction in case fatality
is accomplished by the mere post-ponement
of certain diseases from
ages under five years, even into the
next five-year period. The case fa-tality
for diphtheria is reduced 67
per cent; measles, 92 per cent; scarlet
fever, 74 per cent; whooping cough,
97 per cent, and tuberculosis (all
forms), 86 per cent. The case fa-tality
in these diseases drops off
remarkably even after the third year
of life, and if a child is infected with
tuberculosis in the first year of life,
the risk of dying of it is over twice
as great as if infected in the second
year.
When we have to think of the
costliness of certain procedures, it
is encouraging how much can be ac-complished
for child health through
inexpensive health education. Lead-ers
in our public education systems
proclaim the development of health
as one of the primary purposes of
our public schools. Are we phy-
14 The Health Bulletin January, 19UO
sicians and public health workers
offering them the leadership and en-couragement
to make the greatest
use of their personnel and facilities
in this matter? Are we furnishing
teaching material of special interest
in the different age groups? A good
way to begin is to discuss the lead-ing
causes of illness or disability and
the leading causes of death for the
different age and race groups over
a five or ten year period.
Special emphasis and effort might
well be given to Negro health work
and improvement in our legislation.
From time immemorial, most teach-ing
systems have been based on an
attempt to impart information not
likely to be gathered otherwise by
the individual and too often unlikely
to be useful or needed. Everyone
from the youngest to the oldest is
already deeply and vitally interested
in health, We are fortunate in that
there is no necessity for stimulating
an artificial interest in health. The
task of health education is greatly
simplified by the fact that our hunger
for health facts is spontaneous and
instinctive.
In the very brief time allotted to
me it is impossible to cover more
than the few points which I have
attempted to emphasize. The in-creasing
democratization of health
care is most encouraging. In di-recting
our efforts toward improving
child health, we cannot overlook the
many factors which surround and in-fluence
the child's well-being. Hav-ing
observed that today's adults en-joy
a more abundant life because
of even the partial and incomplete
health care given yesterday's chil-dren,
we are now attempting to com-plete
the cycle by smoothing the way
for tomorrow's children through in-tensification
of health efforts and
providing better preventive care for
the parents and prospective parents
of today. More and more of tomor-row's
children will arrive with a wel-come
greeting from their parents and
with a community ever more ready
to use a larger proportion of avail-able
resources in proving our belief
that children are our most valuable
crop and that child life is far more
worthy of conservation than even our
soil, our forests and our oil resources.
In fact, conservation might well be
our watchword in our consideration
of tomorrow's children.
*Read before the Southern Conference on
Tomorrow's Children, Atlanta, Ga., Novem-ber
10, 1939.
DR. HALL MEMORIALIZES
DOCTORS WHITEHEAD
AND MANGUM
One of the most interesting fea-tures
in the extraordinarily interest-ing
day of activities in connection
with the opening of the New Medical
and Public Health Building at the
University of North Carolina on De-cember
4th was the great address at
the evening session by Dr. James K.
Hall, of Richmond, Va. The Uni-versity
has never had a more loyal
friend than Dr. Hall, a native of Ire-dell
County and a student at the
University with Dr. Clarence Shore,
for so long head of the State Board
of Health Laboratory, and many
other notable men of that period.
Dr. Hall is and has always been
thoroughly steeped in the traditions
of the University. He is not only
one of the institution's most dis-tinguished
graduates who has gone
far in the profession, but he is never
so happy as when lauding the vir-tues
and accomplishments of some
of his fellows.
He paid a beautiful tribute to Dr.
Whitehead, who was Dean of the re-established
or re-organized medical
school when it was opened on a per-manent
basis in 1890, following the
lapse of some years after the initial
January, 191^0 The Health Bulletin 15
efforts of Dr. Harris; and Dr. Charles
S. Mangum, who was Dean of the
school from 1933 to 1938. Dr. Hall
gave Dr. Whitehead ci'edit for laying
the foundation for the school, and by
his professional dignity set such an
example for the young men who
came there as students that has
lasted throughout the years. Dr.
Hall was a student there under Dr.
Mangum, and no preceptor could
dream of having any student in years
to come remember him with more
genuine sincerity and approbation
than Dr. Hall paid to Dr. Mangum.
He said that Dr. Mangum had un-surpassed
ability as a teacher; he
instilled in the student the value of
thorough preparation. He said that
Dr. Mangum was perhaps a better
mixer than Dr. Whitehead and that
in his op^on Dr. Mangum was per-haps
the best ambassador of good-will
that the University has ever had.
He paid tribute to Dr. Mangum for
cooperation with Dr. Reynolds in the
establishment of the Public Health
School and later in bringing Dr.
Rosenau in as head of the institu-tion.
Dr. Hall discussed the history of
the Medical School as perhaps few
other men could have done, because
of the fact that he was relating per-sonal
experiences and passing along
to his hearers the impressions of a
keen mind gained through personal
knowledge.
MRS. DOAK EXPLAINS THE
HUMBUG BUSINESS*
To the Editor:
Your article entitled "Humbugs"
in a recent issue of the Health Bul-letin,
did an injustice to the Raleigh
Woman's Club and its President. Con-stant
inquiries and criticism com-ing
to the President as a result of
your article make it necessary that
she ask you to publish the following,
in justice to herself and the Club:
Your article stated that you had
your "office call the President of the
Raleigh Woman's Club for the pur-pose
of making emphatic protest
against the Club's auditorium being
opened to this faker," referring to
a woman whom you also labeled "a
high-powered adventuress and quack."
Also you stated that it makes you
sore that this woman was able over
your protest "to secure" the audi-torium.
The truth is, the President of the
Club was out of the city when the
clubhouse was rented to the woman
in question and knew nothing of its
rental until two days later, just a
few hours before the woman made
her first lecture. The Chairman of
the House Committee, acting in her
proper authority under the Club's
Constitution and By-Laws., rented
the auditorium to the so-called "fa-ker"
in the absence of any evi-dence
that the woman was such.
Unfortunately, it was three days af-ter
the auditorium had been rented,
two lectures having been made, be-fore
any message of protest from
you reached the House Committee
Chairman. The President never re-ceived
any protest from you or your
office or from anyone else about the
rental or use of the clubhouse by the
woman in question. Acting upon a
suspicion, created by an inquiry from
the Secretary of the Raleigh Y. W.
C. A., a few hours before the first
lecture, the President called the Sec-retary
of the Chamber of Commerce
and inquired if he knew anything of
the woman scheduled to lecture at the
clubhouse that afternoon. He replied
that he thought her to be the same
woman who was once in Asheville and
he was going with the Wake County
Health Officer and a plain-clothes
man to hear her that afternoon and
16 The Health Bulletin January, 1940
would report later. The next day he
telephoned and asked if he might
come and bring the Health Officer.
He did not say then or later that
he was telephoning from or for "your
office," or for you. The gentlemen
called and reported that they had
heard the woman's lecture the after-noon
before and that "she kept within
the law." They had a folder full
of clippings about the woman, but
nothing that could have served the
Club as defense evidence in a suit
for wrongful ejectment had the
woman been ordered to vacate the
auditorium and her money been re-funded.
When the President indi-cated
that she would call the woman
and protest certain of her activities
or ask her to vacate, the Secretary
said that it would not be wise to
cancel the contract for use of the
clubhouse unless stronger evidence
was obtained. This evidence was
never received from the Secretary,
or anyone else, to the regret and
chagrin of the officers of the Club,
and it is presumed, to the State Board
of Health. It was realized that we
were in a predicament from which
we could not legally escape. You
stated in your article that the At-torney
General, the Solicitor, the City
Attorney and all other officers of the
law were powerless to stop the
woman's activities. We, too, found
out that fact and therefore did not
eject the woman and risk a suit we
could not have won.
The officials of the Woman's Club
did not wilfully, or carelessly, as
your article suggests, aid and abet
in putting over on the public what
appears to have been a fraud. If,
as you stated, some of the woman's
activities, in your opinion, "consti-tuted
practicing medicine without a
license from anybody in the State,"
it passes understanding why you did
not have your organization test out
the power of the law in this case
instead of leaving it to the Woman's
Club to pull your chestnuts out of
the fire at the risk of burning its
own fingers.
The Raleigh Woman's Club has al-ways
been the friend of the State
Board of Health and is proud of its
record of helpfulness. If your or-ganization
will have the Attorney
General prepare a law that would
prove adequate to protect the Club
and you in such cases, the Club will
gladly help you to get it through the
Legislature.
Mrs. Chas. G. Doak,
President,
Raleigh Woman's Club.
•Editor's Note: The above communica-tion
of the President of the Raleigh Wom-an's
Club in no way alters, changes or
amends any statement made in the editorial
entitled "Humbugs" published in the Oc-tober
1939 issue of the "Health Bulletin."
LEGAL NOTICE
On the first day of this month
the law requiring a laboratory test
of the blood of every expectant
mother in this State became effec-tive.
This law was passed for the
protection of the unborn babies
and their mothers. Its purpose is
to establish early in the pregnancy
the presence or absence of labora-tory
evidence of syphilis. If pres-ent
and the fact is determined
early enough, competent treatment
may be instituted, and the ex-pected
baby saved from the hor-rors
of syphilis. The mother may
be cured and further ravages of
the disease ended.
The burden of compliance with
the law rests with the woman, but
it is the duty of the attending
physician, or the midwife for those
who depend upon them, to see that
the law is enforced.
The law applies with equal force
to all pregnant women alike. None
is exempt from its provisions.
m..
iOfWte®
PublisKedbv TrtL/^RmCATCLIflA 5TATL5°ARDs^fiB\LTFl
i '
i •
| This Bulletin will be sent free to any citizen of the State upon request |
Entered as second-class matter at Posioffice at Raleigh, N. C., under Act of July 16, i8q4-
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. 55 FEBRUARY, 1940 No. 2
GROUP ATTENDING MATERNITY AND INFANCY CENTER
GREENVILLE
The above photograph is a good illustration of one of the monthly
group clinics for expectant mothers and for babies now being con-ducted
in more than one hundred and fifty places in the State. This
center at Greenville was opened in October, 1936, with one patient.
The group present on December 1 8th, when the above photograph
was made, illustrates the attendance now. Members of the clinic
staff pictured above are Doctors Wilson and Haar, Nurses Matthews,
Crockett and Hilton and Dr. Ennett, county health officer. It is an
efficient group and results in Pitt County compare favorably with
efforts made anywhere in the State in this important work.
)
I
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
8. D. Craig, M.D., President
J. N. Johnson, D.D.S., Vice-President
Q. G. Dixon, M.D
H. Lbb Large, M.D _ _
H. G. Baity, ScD
W. T. Rainby, M.D
Hubert B. Haywood, M.D
J. LaBrdce Ward, M.D.
C. C. Fordham, Jr., Ph.G...
Wintton-Salem
Goldsboro
Ayden
Rocky Mount
Chapel Hill
Fayetteville
Raleigh
Asheville
Greensboro
Executive Staff
Carl V. Reynolds, M.D., Secretary and State Health Officer.
G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Health
Education, Crippled Children's Work, and Maternal and Child Health Service.
Warren H. Booker, C.E., Director Division of Sanitary Engineering and Malaria
Control.
Ernest A. Branch, D.D.S., Director Division of Oral Hygiene.
John H. Hamilton, M.D., Director Division of Laboratories.
J. C. Knox, M.D., Director Division of Epidemiology and Venereal Disease Control.
R. T. Stimpson, M.D., Director Division of Vital Statistics.
R. E. Fox, M.D., Director Division of County Health Work.
T. F. Vestal, M.D., Director Division of Industrial Hygiene.
FREE HEALTH LITERATURE
The State Board of Health publishes monthly THE HEALTH BUL-LETIN,
which will be sent free to any citizen requesting it. The Board
also has available for distribution without charge special literature on the
following subjects. Ask for any in which you may be interested.
Adenoids and Tonsils
Appendicitis
Cancer
Constipation
Chickenpox
Diabetes
Diphtheria
Don't Spit Placards
Eyes
Flies
Fly Placards
German Measles
Health Education
Hookworm Disease
Infantile Paralysis
Influenza
Malaria
Measles
Pellagra
Residential Sewage
Disposal Plants
Sanitary Privies
Scarlet Fever
Smallpox
Teeth
Tuberculosis
Tuberculosis Placards
Typhoid Fever
Typhoid Placards
Venereal Diseases
Vitamins
Water Supplies
Whooping Cough
SPECIAL LITERATURE ON MATERNITY AND INFANCY
The following special literature on the subjects listed below will be sent
free to any citizen of the State on request to the State Board of Health,
Raleigh, N. C.
Prenatal Care
Prenatal Letters (series of nine
monthly letters)
The Expectant Mother
Breast Feeding
Infant Care. The Prevention of
Infantile Diarrhea.
Table of Heights'and Weights
Baby's Daily Time Cards: Under 5 months;
5 to 6 months; 7, 8, and 9 months; 10,
11, and 12 months; I year to 19 months;
19 months to 2 years.
Diet List: 9 to 12 months; 12 to 15 months;
15 to 24 months; 2 to 3 years; 3 to
6 years.
Instructions for North Carolina Midwives.
CONTENTS
Notes and Comment Page 8
Should Children's "Catching Diseases Be Gotten Over With" Before
School Age? Page 4
Twenty-Five Thousand American Babies Die Each Year from Syphilis Page 6
Distinguished Visitors Guests of the Division of Industrial Hygiene Page 7
Vitamin Chart Page 8
Mineral Chart Page 9
Systematized Medicine Page 10
The Sixteenth Decennial Census Page 12
Burns Kill One Hundred and Twenty North Carolina Children Annually Page 13
Outlaw the Firecracker Page 14
Public Health and Christian Sociology Page 14
Clyde Shaver Page 16
ttS?
Vol. 55 FEBRUARY, 1940 No. 2
Notes and Comment
By The
A S these lines are written in Janu-
^^ ary for those of our readers who
may be interested in our editorial
material to read in February, and as
snow and ice and bad weather may
be the rule in both months, affording
more time for reading, the descrip-tion
we have here of one of the
great institutions of the South may
be as interesting to some of our read-ers
as it has been to me.
The Editor had the privilege of at-tending
the annual meeting of the
Southern Medical Association in Mem-phis,
Tenn., last November. The vari-ous
sections, especially those on pub-lic
health, were full of interesting
and valuable information for all the
physicians and public health workers
in the South. The scientific exhibits
were the best the Association has
ever presented. Notable in the group
was the exhibit on human bones sent
down by the Orthopedic Department
of Duke University Medical School.
This attracted a great deal of amaze-ment
among the physicians and visi-tors
on account of the wide scope of
material presented. Dr. Baker and
his associates and the Duke Medical
School are to be highly commended
for their patience and thoroughness
in assembling this exhibit. The Dean
of the Duke Medical School has in-formed
us that work has been going
on in assembling this exhibit for the
past nine years.
We started out, however, to de-scribe
for our readers one of the
Editor
most notable institutions anywhere
in the Southern States, and that is
the Baptist Memorial Hospital and
Physicians' and Surgeons' Building
in Memphis. On arriving in Mem-phis
late in the afternoon, we found
that we had been mixed up on hotel
reservations, and every hotel and
reputable boarding house in the city
was full to overflowing. It looked
at one time as if we would have to
start on back home to get somewhere
to sleep. About this time, however,
a young woman in the lobby of one
of the hotels, who seemed to be head
of the information service for visitors
attending the meeting, overheard us
mention the word Raleigh. She im-mediately
came up and introduced
herself and wanted to know if we
were from Raleigh. On learning of
our difficulty in getting quarters, she
immediately arranged for us to be
put up in the hotel division of the
Baptist Hospital. This was some-thing
new to us, but we were very
grateful. It turned out that the
name of this woman is Miss Annie
Laurie Anthony and she had gradu-ated
from Meredith College when it
was located on the square near the
Governor's Mansion in Raleigh. She
had many friends here and had vis-ited
some of them the past summer.
On getting out to the hospital and
presenting her memorandum, we
found that she was highly respected
in Baptist Hospital and medical cir-cles
in Memphis.
The Health Bulletin February, 19bO
We were assigned a beautiful room
with sound-proof walls, equipped as
well as the most expensive modern
hotel. We noted the following state-ment
in the room assigned to us,
and we can bear witness to its truth-fulness:
"The South's greatest hos-pital.
The most complete service of
any hospital in the United States.
Five Hundred beds, splendid hotel,
doctor's office building, grill, drug
store, barber shop, beauty shop,
flower shop—all under one roof and
a garage adjoining."
The foregoing paragraph is not any
exaggeration. We found on visiting
about the hospital all of it to be true,
and in addition, the day we were
there they had six hundred employees
and four hundred patients in the
hospital. Medical and surgical ser-vice
and clinics for the poor were
provided for every day in the hos-pital.
There was absolutely no con-fusion
and a stranger would not have
known whether he was in a hospital
or a hotel most of the time. It is
the best systematized and convenient
institution we have ever seen. Many
of the leading physicians, including
some nationally known specialists,
have their offices in the section of
the building known as the physicians'
and surgeons' division.
The visit to Memphis would have
been amply repaid if we had seen
nothing connected with the great
medical meeting there except the con-duct
of this hospital. The Editor of
the Health Bulletin has felt for a
long time that one of the needs in
every city and town where people
come from outside to bring their
friends and loved ones to the hos-pital
for surgical or medical treat-ment,
is additional quarters on or
near the hospital grounds, where
they can find food and lodging at
a reasonable price. This hospital in
Memphis meets all these needs and
many more. We do not know who
designed this hospital, whose ideas
were the prevailing ones in its con-struction,
but we do know that in
the institution the Baptist Church
has a monument in that section of
the country which would be hard to
approach anywhere we have ever
been. It is said that no patient of
any denomination is ever turned away
from that institution, whether or not
they have the money to pay for it,
and yet the millionaire can receive
the very best medical and surgical
service that the South affords right
under the same roof with the wide-spread
sectional service to the poor.
We are under many obligations to
Miss Anthony, and we can say with-out
any hesitation that Meredith Col-lege
has a graduate in that great
Southern city of whom it can well
be proud.
Should Children's "Catching Diseases Be
Gotten Over With" Before School Age?
By Roy Norton, J. C. Knox and R. T. Stimpson
PARENTS and teachers have laid
a great deal of stress on perfect
attendance records in the public
schools and Sunday Schools. No one
would minimize the importance of
thore-aghness and punctuality in
child-training, but a certain amount
of reasonableness should temper our
attempts at teaching discipline. Some
hard-driving parents feel that their
child should capture all the records
and prizes and some of our present
February, 19U0 The Health Bulletin
North Carolina school regulations
perhaps unduly penalize the occa-sional
health-serving absences from
school.
Is there a health reason against
exposing a very young child to the
"catching diseases" so that he or
she can be more likely to have a
perfect school attendance record? Do
children withstand the children's dis-eases
better the younger they are?
Most children have measles and
whooping cough anyway. Isn't it
desirable to expose them sometime
before school age in order not to
interfere with school attendance and
to avoid the chance of the disease
"going harder" with them when they
are older? Not enough thought and
study have been given to the bear-ing
of health in these questions.
Given a certain number of cases of
these childhood diseases at a young
age group and an equal number at
a later period, is there a significant
difference in the likely number of
deaths (or as doctors refer to it, the
case-fatality) from the diseases?
To obtain the answer to some of
these vital questions, State Board
of Health reports of cases of disease
received by the Division of Epidemi-ology
and death certificates received
by the Bureau of Vital Statistics
have been studied for the most re-cent
five-year period. Even though
there may be a closer approach to
completeness in the reporting of
cases in older age groups and per-haps
other minor considerations, the
suggestions made by the available
material are definite and clear-cut
as is indicated by the following table
for 1934-1938, inclusive:
The Health Bulletin February, 19kO
Twenty-Five Thousand American Babies Die
Each Year from Syphilis*
By Jay M. Arena, M, D., Durham
JV/fOST people know vaguely that
1V1 syphilis is a disease that can be
transmitted from parents to their
children. They do not know, how-ever,
how this infection of the chil-dren
is brought about, how it can
bo cured if it does occur, and most
important of all, how it can be pre-vented.
Lack of knowledge is at
the root of much misunderstanding
concerning this particular disease.
This article is one of the series ap-proved
by the Durham-Orange County
Medical Society in its effort to re-duce
infant mortality.
If a syphilitic mother becomes
pregnant, the minute corkscrew germs
of the disease may circulate in her
blood and reach the baby in her
womb. After the baby becomes in-fected,
several things may happen.
The baby may be so poisoned by the
syphilitic germs that further life and
growth are impossible, and a mis-carriage
follows. It may happen
that, though the baby may continue
to live in the womb for some time,
the accumulation of syphilitic poisons
in its body will cause it to be born
dead, often prematurely. If by
chance the infant is born alive, pre-maturely
or at full term, he may be
so enfeebled that he may die in the
course of a few weeks. Or the baby,
if born apparently healthy, may de-velop
the symptoms of syphilis weeks,
months or years later, for example,
wasting, skin rashes, sores that
leave ugly scars, deformed bones, bad
teeth, blindness, deafness, paralysis,
and feeble-mindedness. On the other
hand, many of these syphilitic chil-dren
show none of these external
signs or symptoms, and unless blood
tests are made during routine phy-sical
examinations, the disease may
not be detected.
Syphilis in children who are in-nocent
victims of their mother's dis-ease,
is curable only if treatment is
begun early enough and is carried
out systematically and thoroughly.
The best time to cure the disease is
before the baby is born. If a syphi-litic
mother begins her treatment
early in pregnancy, during the first
three months, infection of the baby
can be prevented altogether. Treat-ment
drives the syphilitic germs out
of the mother's blood, so that they
can no longer travel into the womb
to the baby. Even if the syphilitic
mother's treatment is not started un-til
the fourth or fifth month of preg-nancy,
there is still a good chance
for the baby to be healthy. No stage
of pregnancy is too late, and some-thing
can still be done to help cure
both the mother and baby even as
late as the ninth month. From the
child's point of view, one treatment
of the mother before confinement is
worth several given to the child after
birth. Children whose mothers have
received insufficient or no treatment
before their birth, and who are either
born with or develop symptoms of
syphilis, can still be cured. Treat-ment
should be continuous for from
seventy-five to eighty-five weeks.
When a child is found to have syph-ilis,
it is important that the mother
and father and also the brothers and
sisters be examined, and receive treat-ment
if necessary, otherwise many
of them may develop various dis-tressing
symptoms of this disease
at some later period in life.
February, 191*0 The Health Bulletin
Diagnosis and treatment of syphi-lis
in adults before they become pa-rents
prevent the transmission of the
disease to their children. Many
adults who have had syphilis neglect
to obtain a complete cure and often
marry before it is safe for them to
do so. Again, people may not know-that
they have been infected with
syphilis. Such persons may infect
their husbands, wives, or children
with the disease.
In order that syphilis in children
may be prevented, every woman
should have her blood tested by her
physician and also have a complete
examination as soon as she thinks
she is pregnant. This measure is
the only way at present to stamp
out syphilis in children. Recently a
law has been passed in the State
of North Carolina requiring not only
physical examination, but also a blood
test (Wassermann) from a reputable
laboratory, indicating the absence of
venereal disease in both partners be-fore
a license to marry can be is-sued.
This law should prove a great
asset in the prevention of this pre-ventable
disease in children. Fur-thermore,
through the State and
county boards of health and the
Reynolds Fund, free clinics for the
treatment of syphilis have been es-tablished
throughout the State. Ap-proximately
3,000 patients are be-ing
treated in Durham today, and
there is no excuse for anyone to fail
to be cured if he or she will find
out whether syphilis is present by
having a blood test (Wassermann)
done and taking adequate and pro-longed
treatment by their own phy-sician
or at a clinic, if they cannot
afford private care. If adults would
only avail themselves of the facilities
available in Durham, syphilis would
disappear and children would not b&
infected by their parents. Find out
before it is too late, and be cured.
From a series of articles published in
the newspapers in Durham under the spon-sorship
of the local Medical Society.
DISTINGUISHED VISITORS
GUESTS OF THE DIVISION
OF INDUSTRIAL HYGIENE
The Division of Industrial Hygiene
was host in December to Dr. Greg-orio
D. Dizon, of the Federal Depart-ment
of Health, Commonwealth of
the Philippines, and Dr. Victor Nasa-tir,
of the City of Los Angeles Health
Department. These gentlemen direct
the occupational disease preventive
activities in their respective depart-ments
and came to North Carolina
at the suggestion of the United States
Public Health Service to observe the
scope of such work in this State.
While in North Carolina they were
shown furniture plants, foundries,
stone-cutting sheds, brick and tile
plants, granite quarries, mining op-erations,
mineral-grinding plants and
asbestos textile plants. With respect
to each type of industry both prop-erly
safeguarded and unsafeguarded
work-room conditions were demon-strated.
The occupational disease
hazards involved were those arising
from exposure to siliceous dusts and
volatile solvents.
In February, Mr. Robert Lam, In-dustrial
Hygiene Engineer of the
Honolulu Health Department, Hawaii,
is to be the guest of the Division of
Industrial Hygiene. Mr. Lam plans
to work with the Division engineers,
on their regular field assignments.
The coming of these visitors to
the State attests the esteem with
which the United States Public Health
Service regards the work of our Di-vision
of Industrial Hygiene.
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10 The Health Bulletin February, 19UO
Systematized Medicine
By William H
Read Before a Conference of
A MONG the many incoordinated
** things in our present way of
living is the fact that for a long
time there has been many people
of the poorer class who have needed
medical attention and have not re-ceived
it, and that there has been
an adequate number of physicians to
give this care. This incoordination
has been due to two factors, chiefly,
one the hesitancy of the people to
seek medical attention when they
could not pay for it, and the other
the inability of doctors to devote a
large portion of their time to un-compensated
practice. Doctors have
always gladly treated the charity
patients and in a great many in-stances
thoroughly enjoyed it, but
due to the fact that most physicians
are solely dependent on their practice
for a livelihood they have to devote a
large percentage of their time to prac-tice
from which they will receive
compensation. The care of the poor
has been a concern of people from
time immemorial, and in some of the
European countries a systematized
effort to help these people was made
a good many years ago. Here in
America, except for the County
Homes, the State institutions for the
treatment of mental and tubercular
cases and for part charity hospitals,
no systematized effort has been made
until the passage of the Social Se-curity
Act of 1935 by the Federal
Congress. As you know, the part
that is in operation now is concerned
with unemployment insurance and
old age pensions, but the scope of
this Act encompassed medical care
for those who could not pay for it.
Following the passage of this Act,
President Roosevelt in 1935 appointed
a committee which was called the
. Smith, M. D.
Social Agencies at Goldsboro
Interdepartmental Committee, "To co-ordinate
health and welfare activities
in order that the full benefit of the
varied Federal programs under the
Act might reach with minimum delay
and maximum effectiveness the indi-vidual
man, woman and child for
whose aid and service the program
was brought into existance."
This Interdepartmental Committee
held a conference in July 1938
to which representatives of or-ganizations
interested in health were
invited. At this conference the com-mittee
made a report and also recom-mendations,
which were presented to
President Roosevelt. This report and
recommendations were based on the
findings of what is known as the
Technical Committee on Medical care.
This Technical Committee has made
surveys and other investigations of
the health and facilities for medical
care, such as hospitals, etc., in the
United States and has spent two
years in conducting these investiga-tions.
Their recommendations con-cerned
all phases of preventive medi-cine,
as well as the care of the sick.
In the field of preventive medicine,
their recommendations concerned ve-nereal
diseases, maternal and child
welfare, prevention of tuberculosis
and other phases of preventive medi-cine
and public health.
Their recommendations for the care
of the sick concerned increasing the
number of hospitals in the United
States, subsidizing hospitals, increas-ing
the number of diagnostic centers
and for the medical profession a most
important thing, that physicians be
paid for their work among those un-able
to pay for it. To pay for the
care of the sick the committee recom-mended
compulsory insurance.
February, 1940 The Health Bulletin 11
Since this conference, which was
held in 1938, there has appeared
a great many articles in news-papers
and magazines concerning
these recommendations and particu-larly
the attitude of organized medi-cine
towards the proposed changes.
While doctors are organized fairly
well, it is chiefly for scientific pur-poses.
The large majority of phy-sicians
are highly individualistic and
are concerned solely with the care
of their patients, hence do not take
much interest in economic conditions
or the social aspect of medicine.
For this reason the individual phy-sician
has left these things to the
heads of the medical organizations
and the individual should not be
criticized for his lack of cooperation
with the Government in working out
plans for the care of the needy. The
recommendations of the Interdepart-mental
Committee will probably be
taken as a basis for laws to be passed
by Congress and a study of these
recommendations leads one to believe
that treatment for the poor will be
made more available.
When this program is set up, the
poor will feel that they are entitled
to medical care and will more fre-quently
seek it, and on the other hand
the medical profession will be paid
for their services, although at a re-duced
rate, and for that reason will
be able to give more time to the
care of the poor without suffering so
much financial loss. The early and
adequate treatment of disease will
probably mean increased hospitaliza-tion,
as intelligent supervision by the
Government will cause this class of
people to be treated in the hospitals
rather than in their homes. This
statement is made because it is known
that inadequate nursing care such as
they would get in their homes and
unavailability of special treatment
would make home treatment unsatis-factory
and the best results could not
be obtained. Another advantage of
hospitalization would be the fact that
physicians could more easily treat
these patients in a hospital for the
reason cited in the preceding sen-tence,
and with the temperature,
pulse and other data recorded in a
hospital, less time would be necessary
for each patient. This would enable
the physician to look after these peo-ple
with less time-consuming effort
and with more success, which would
bring satisfaction both to the phy-sician
and the patient.
The medical profession is not antago-nistic
to this program, especially after
they study it for a while, as they will
see they will be benefitted along with
the community. They are antagonis-tic
to a possible administration of
these health activities by a bureau
made up of politicians and adminis-tered
by politicians. That is the
reason that the medical profession
in America has been against what
is usually termed socialized medicine.
If a fair and just administration
would carry out this program in a
way it should be carried out, I am
sure the medical profession will give
its whole-hearted support and will
work as hard and eager as anyone
to make a success of it. The pro-fession
has been known for a great
many years as being an altruistic
body of men working solely for the
interest of their patients, giving little
heed to their own betterment and
asking in return for their work only
enough financial returns to maintain
them and their family in livable con-ditions.
The profession has also been
known for years to push forward any
measure that would make for better
health of the individual and the com-munity.
If it were not for this fact
the campaign for the eradication of
typhoid fever, diphtheria and other
communicable diseases would never
12 The Health Bulletin February, 19HO
have succeeded. The public should
be just as interested and just as
eager to see that this program is
administered in a way it should be
administered, as the medical profes-sion,
because it is for the better-ment
of the public and if it is left
to grasping, graft-seeking politicians,
the public is going to suffer more
than the medical profession.
We plead with this body and all
other organized bodies looking to
the betterment of the community to
work with the medical profession and
see that this program is adminis-tered
wisely and fairly.
The Sixteenth Decennial Census
Friendly Cooperation of the Public Desired
By the United States Census Bureau
pACTS of vital interest and defi-
* nite value to health authorities
and the populace at large are now
being gathered by the United States
Bureau of the Census, in connection
with the comprehensive Sixteenth
Decennial Census of the United
States. These facts, when gathered
and tabulated, will cover virtually
every phase of human life and ac-tivity,
and particular attention is be-ing
paid in observing those indica-tions
of community health—housing
conditions, domestic sanitation facili-ties,
family income, occupations and
the like.
The Sixteenth Decennial Census is
really eleven different inquiries, each
complete in itself and to be taken or
already under way on a nationwide
basis. Early in January, the Census
of Business, the Census of Manufac-tures,
and the Census of Mines and
Quarries were begun. The Business
and Manufactures enumerations are
taking stock of every angle in pro-duction
and distribution of drugs and
medicines, hospital and surgical sup-plies
and equipment, sickroom items,
etc. Every drug store and commer-cial
pharmacy in the country is be-ing
called on, as also are labora-tories,
supply houses and chemical
plants, and so on.
Hospitals, since they are classed as
professional institutions, are not be-ing
enumerated. But as the homes
of nurses, doctors and other resi-dent
employees and staff members,
they will be visited by Census of
Population enumerators, beginning in
April, and employees and permanent
patients or inmates will be inter-viewed.
Every individual in the
country must be enumerated, either
personally or through some responsi-ble
person.
Questions asked will concern age,
nativity, family background, educa-tion,
occupation, extent of employ-ment
in 1939, income, and so on.
To define migration trends for the
country as a whole, one question will
ask "Where did you live five years
ago ?»
The Census of Housing, to be taken
concurrently with the population
count, is of particular interest to
health officials since this survey will
uncover, for the first time in Ameri-can
history, facts pertaining to homes
throughout the Nation. Every dwell-ing
will be surveyed, from the White
House at Washington to the sheet-iron
shacks down by the railroad yards
and the dump. Typical of the ques-tions
to be asked are the following:
What is the size of this home?
What is its value? Who owns it?
What are the monthly bills? Does
it have running water? Hand pump?
Water supply less than 50 feet from
February, 1940 The Health Bulletin 13
house? More than 50 feet? Flush
toilet? Chemical toilet? Private, or
shared with other households? Out-side
toilet? None at all? Bathtub?
Refrigerator? Radio? How old is
the dwelling? What is its condi-tion?
How many people live in it?
How is it heated? What fuel is
used for heating? What fuel is
used for cooking?
Answers to these questions, tabu-lated
and correlated with vital sta-tistics
and other pertinent figures for
the same areas, will be tremendously
valuable in analyzing the state of a
community's health. In those cities
where the Census Bureau cooperates
with local committees in the study
of Census tracts, these figures will
be in connection with studies con-cerning
the solutions to local prob-lems
of health, crime, relief, schools,
etc.
Similarly, the Census of Agricul-ture,
besides going thoroughly into
the collection of facts on farming
proper, will also unearth significant
information on rural life and incomes.
Sharecroppers, tenant farmers, as
well as plantation owners, and so
on, will all be called on for reports.
Accurate and complete answers to
Census questions are required by Act
of Congress. The same statute, how-ever,
prohibits the Census Bureau
from revealing individual statements.
Reports are seen only by sworn em-ployees,
and facts can be released
only in broad statistical form. The
use of Census declarations for pur-poses
of taxation, regulation or in-vestigation
is prohibited.
Burns Kill One Hundred and Twenty North
Carolina Children Annually*
By R. R. Jones, M. D., Durham
DURNS and scalds are too common.
*-* Last year forty people were ad-mitted
to Durham hospitals suffering
from severe burns, and four Durham
children died. Frequently, a se-verely
burned child spends months in
the hospital, and may need a year
or more of hospital care to correct
the deformities resulting from ex-tensive
burns.
The majority of burns are pre-ventable,
and prevention is the best
treatment of this type of injury.
Open fires and hot stoves should be
protected by adequate screens. Chil-dren
should not be allowed to play
with matches, or in the kitchen while
cooking is being done. Hot liquids
should be placed well out of their
reach, and since a certain number
of mouth and gullet burns come from
swallowing lye and acids, these poi-sons
should be kept where they can-not
be tasted by inquisitive infants.
Fireworks and cap pistols may cause
dangerous powder burns. It is ob-vious
that burning clothing should
be extinguished promptly with water
or by wrapping the child in a rug
or coat.
If in spite of precautions a child
is burned, the seriousness depends
upon the size and depth of the burn.
Relatively small burns in a child may
prove more serious than a larger
burn in an adult, and therefore a
physician should be called at once
and cod liver oil, olive oil, vaseline or
a paste of baking soda mixed with
water placed on the burn while wait-ing
for the doctor to arrive. If the
burn is extensive, all clothing should
be removed and the child wrapped
in a clean sheet and then in a warm
14 The Health Bulletin February, 19U0
blanket. Chilling especially should
be avoided. All severely burned chil-dren
should be taken to a hospital
as soon as possible.
Small burns should be treated by
dressings of absorbent cotton or
clean linen saturated with cod liver
oil. Burns should be kept as clean
as possible. Soot, cobwebs and dirty
dressings should be avoided. Super-ficial
burns seldom become seriously
infected if simple precautions and
clean dressings are used. If blisters
are present, they may become in-fected
and require a physician's care.
Deep burns almost always are in-fected
and should be treated in a
hospital; recovery is possible if treat-ment
is prompt and prolonged. Large
areas of skin loss may be covered by
skin grafts and deformities can be
prevented by adequate care.
From a series of articles published in
the newspapers in Durham under the spon-sorship
of the local Medical Society.
OUTLAW THE FIRE-CRACKER
Many a fine boy in America has
spent his last active Christmas. Some
are in hospitals with serious injuries,
some are maimed or blinded for life,
others are in their graves.
The present young generation has
many pleasures and recreations as
compared with boys of former gen-erations.
And for this reason the
present generation of kids should be
willing to dispense with the fire-cracker,
which is an intolerable nuis-ance,
and a danger to life and prop-erty.
Many a destructive conflagra-tion
results from these explosives in
the hands of boys.
Forsyth and other counties, cities
and towns have made it a misde-meanor
to sell or shoot firecrackers.
Many people—probably 90 per cent
of Stokes—would be glad to see this
vicious toy outlawed in this county.
It is useless and always a danger. —The Danbury Reporter.
Public Health and Christian Sociology
SOMETIME ago a friend informed
the Editor of a most interesting ser-mon
she had heard from the Pastor,
Rev. Donald H. Stewart, in the Pres-byterian
Church in Chapel Hill. The
friend told us that it was so similar
to the things we have been saying
here for so long that she was sorry
the Editor was not there listening.
We immediately wrote to Mr. Stew-art
and requested a copy of his ser-mon
with permission to publish it in
the Health Bulletin. Instead of get-ing
a copy of the sermon he sent us
something that is better, that is, a
condensed article which Mr. Louis
Graves, Editor of the Chapel Hill
Weekly, had requested Mr. Stewart
to prepare, based on the investiga-tions
of Mr. Stewart which had caused
him to prepare and deliver the ser-mon
he did. Mr. Stewart very kindly
sent us a copy of the article published
in the Chapel Hill Weekly, and we
feel sure that Mr. Graves will not
object to our giving the readers of
the Health Bulletin the benefit of this
excellent article, which we publish
in full below.
We feel confident that our readers
will readily understand that the con-ditions
Mr. Stewart cites are not
at all peculiar to Chapel Hill. In
fact, many of us know of several
villages and towns in North Carolina
that have living conditions worse
than those described in this article.
We also know that some of the most
sordid conditions due to a combina-tion
of such diseases as syphilis or
tuberculosis with poverty are to be
found in our rural sections. The
purpose in preaching and writing
about such ills is to stimulate our peo-ple
to action which will eradicate them.
February, 19A0 The Health Bulletin- is
Responsibility for Bad Housing,
Poverty and General Distress
Rests* With "Good" People
of Community, Declares
Mr. Stewart
When we were told of a sermon
which Rev. Donald H. Stewart had
delivered in the Presbyterian Church,
about the distress among the poorer
people of the Chapel Hill community,
particularly Negro people, we asked
him to write an article on the sub-ject
for the Weekly.
By Rev. Donald H. Stewart
The harm that "good" people do
is more destructive than the openly
unsocial acts of the avowedly "evil"
man. This is due to the fact that
the predatory acts of the "good" per-son
are covert. Their submerged na-ture
and the remoteness of their end
results ensure them a long term of
unobserved destruction. We are
shocked when one man openly shoots
down another, but one wonders
whether we are as sensitive as we
should be to the long-range murder
which a privileged group imposes
upon the victims of its prestige.
The "good" man, the respectable
bourgeois, the "gentleman" is never
in fact as gentle as he thinks he is.
It is not an easy, and certainly not
a comfortable thing to have to ad-mit
that we are the instruments of
unrighteousness to a greater ex-tent
than we are apt to assume.
In the section of the local Negro
community known as "Sunset," 60
per cent of which is within the town
limits, even after the improvements
which have been made in the last
year are taken into account, the fol-lowing
condition exists:
Of the 72 houses, only 10 have
water connections with spigots inside
the house. Only 6 have baths; 56
have privies. Only 15 have com-modes
and water laid on inside house.
Four have no privy.
In this area there are 5 or 6 open
wells or springs which are pronounced
unsanitary and from which many of
these people must presumably get
their drinking water. In one place
one outside spigot serves for the
water needs of the 8 homes in the
immediate vicinity, not counting
others which have recourse to it by
reason of their lack. Hog pens, cow
lots and chicken lots are often sus-piciously
near the open wells.
There are but 5 telephones in the
entire Negro community, and 2 of
these are in the Negro business dis-trict.
When we add to this the fact
that the only hydrant available for
the "Sunset" district reposes in
"civilized" isolation on Rosemary
Street it is obvious that the fire
hazard for these people is enormous.
The low-bracket money-level of the
occupants causes little interest in the
landlords and little ability in the oc-cupants
to keep many of the homes
weather-proof, screened, etc. Only
10 per cent of the colored homes
have adequate screens, 20 per cent
have only part screens, while 70
per cent have none whatever. Only
5 per cent have proper garbage stor-age,
while 95 per cent have no method
of garbage disposal whatever.
In one house there live 10 per-sons
in three rooms. There are
the mother and three illegitimate
children, and the grandmother, who
is the only bread-winner for these
five. She gets $5 a week for half-time.
In the same three rooms live
another family, a man and his wife
and three children, the last of which
has just arrived. The mother of
the first three is an open syphilitic
and lies on a bed adjoining the new
born infant. Cases of other kinds
like this can be cited.
These are the lives in part (the
half has not yet been told) of those
who wash our clothes, tend our ba-bies,
mow our lawns, cook our meals,
fire our furnaces, etc. They live on
the rim of the world's life. Surely
one cannot refrain from asking, just
how gentle is the "gentleman" in a
society where the half-stuffed and
the half-starved thus live next door
in the story of the modern Dives and
Lazarus? In contrast to the "de-lightful"
residential district of Chapel
Hill there is another section where
the dwellers awake to the grim dawn
of the silhouetted and omnipresent
privy; to behold, instead of lawns,
a tousled and matted grass; instead
of cement highways, the bare and
often unkempt earth; to live their
day from dawn 'til dusk with little
to encourage and much to defeat
them. Where beauty and order hare
arisen it is often the child of a
decencjr and courage preserved some-times
amid heart-rending conditions,
amid difficult conditions always.
16 The Health Bulletin February, 1940
Before we crawl into the time-honored
refuge of the dishonest ar-gument
that shiftlessness and inca-pacity
alone are the cause of this
bleeding edge of human life, let us
be honest enough to admit that we
have first penalized poverty, and
that there is more spoil of the poor
in our house than we can comfortably
account for upon the legitimate basis
of animal lethargy in the dispos-sessed.
The wasted land and the
jaded people are in fact a check re-turned
by the dispossessed upon the
society of the possessor, and marked
"insufficient funds," a condition of
bankruptcy brought about largely by
man's attempt to strike a bargain in
human flesh and land.
That there is some awareness of
responsibility is manifest in the splen-did
work of the Negro Community
Centre just launched, let us hope to
a wide and long service. The Crip-pled
Children's work; the Handicraft
program recently opened in the
grammar school; the tuberculosis
work of the Community Club, etc.,
are all to the good. However, they
will need to be supplemented by some-thing
much more adequate than any-thing
which the merely charitable
gesture can suffice to accomplish.
Perhaps our anaesthetized emo-tions
can be aroused to something
like honest dissatisfaction when
we realize that in the county of
Orange four Health Department
workers are carrying nearly 1,500
cases in over 700 families. We ought
to be shocked to know that the Wel-fare
Department is attempting to do
the impossible when it is given $1,750
per year for general relief, and $3,000
per year for hospitalization in a
county of a population of 26,000.
Must we not start a housing pro-ject?
Eventually, why not now?
Could not the newly organized young
women undertake the greatly needed
"Baby Conference" (clinic) ? Is not
the inhabitant of Orange County able
to do far more than he is now doing
toward financing the tonsil removals
and the eyeglasses for those school
children who need them but cannot
obtain them? Are there not many
needed articles of clothing that might
be made by the sewing groups and
presented to the points of greatest
need and maximum service under the
guidance of the Health and Welfare
Departments? Is there not much
educational work to be done?
The need is greater and deeper
than any of us suppose. I am in-formed
that checks and notices of
gifts available may be sent to Mr.
George Lawrence, the Director of
Field Work in the School of Social
Work. He may be reached at the
Bynum Gymnasium.
Surely, an honest repentence and a
disciplined renunciation must follow
upon the certain knowledge that it
is a killing and not a living that we
have been out for. This is our deso-lation.
In this family catastrophe
none of us is guiltless.
CLYDE SHAVER
Miss McVeigh Hutchison, one of
our staff nurses, sends in the above
picture of Clyde Shaver, a Stanly
County school boy who brought a
pumpkin to school and sold it for
money enough to buy himself a new
toothbrush—proving that where there
is a will there is usually a way.
PublisKedby mL/WmCHKIINA. STATL5°ARD5^fl^LTfl ^^——
—
mmmmmmmmmmi^mmmm—i—————————
I This Bulletin, will be servt free to any citizen, of the State upon, request I
Entered as second-class matter at Pusiojfice at Raleigh, N. C, under Act of July 16, 1894.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. 55 MARCH, 1940 No. 3
FIGHTING HIS WAY BACK TO HEALTH
The above is a picture of Jack Angel, son of Mr. and Mrs. Cecil Angel, of
Burnsville, a "polio" victim, patiently carrying out the prescribed treatment
in an effort to recover the use of his paralyzed muscles. The photograph
illustrates the infinite care, patience and persistence necessary for the suc-cessful
treatment of these children, and now being provided for hundreds of
them in all sections of North Carolina. The expansion of this work was made
possible four years ago through the allocation of Social Security funds by
the United States Children's Bureau. The work is carried on by the State
Board of Health and the State Orthopedic Hospital.
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
S. D. Craig, M.D., President „..Winston-Salem
J. N. Johnson, D.D.S., Vice-President...- _...Goldsboro
G. G. Dixon, M.D - Ayden
H. Lee Lakge, M.D -Rocky Mount
H. G. Baity, ScD - —Chapel Hill
W. T. Rainey, M.D..___ - -Fayetteville
Hubert B. Haywood, M.D - — — Raleigh
J. LaBkccb Ward, M.D — Asheville
C. C. Fordham, Jr., Ph.G Greensboro
Executive Staff
Carl V. Reynolds, M.D., Secretary and State Health Officer.
G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Health
Education, Crippled Children's Work, and Maternal and Child Health Service.
Warren H. Booker, C.E., Director Division of Sanitary Engineering and Malaria
Control.
Ernest A. Branch, D.D.S., Director Division of Oral Hygiene.
John H. Hamilton, M.D., Director Division of Laboratories.
J. C. Knox, M.D., Director Division of Epidemiology and Venereal Disease Control.
R. T. Stimpson, M.D., Director Division of Vital Statistics.
R. E. Fox, M.D., Director Division of County Health Work.
T. F. Vestal, M.D., Director Division of Industrial Hygiene.
FREE HEALTH LITERATURE
The State Board of Health publishes monthly THE HEALTH BUL-LETIN,
which will be sent free to any citizen requesting it. The Board
also has available for distribution without charge special literature on the
following subjects. Ask for any in which you may be interested.
Adenoids and Tonsils German Measles Scarlet Fever
Appendicitis Health Education Smallpox
Cancer Hookworm Disease Teeth
Constipation Infantile Paralysis Tuberculosis
Chickenpox Influenza Tuberculosis Placards
Diabetes Malaria Typhoid Fever
Diphtheria Measles Typhoid Placards
Don't Spit Placards Pellagra Venereal Diseases
Eyes Residential Sewage Vitamins
Flies Disposal Plants Water Supplies
Fly Placards Sanitary Privies Whooping Cough
SPECIAL LITERATURE ON MATERNITY AND INFANCY
The following special literature on the subjects listed below will be sent
free to any citizen of the State on request to the State Board of Health,
Raleigh, N. C.
Prenatal Care Baby's Daily Time Cards: Under 5 months;
Prenatal letters (series of nine 5 to 6 months; 7, 8, and 9 months; 10,
monthly letters) 11, and 12 months; 1 year to 19 months;
The Expectant Mother 19 months to 2 years.
Breast Feeding Diet List: 9 to 12 months; 12 to 15 months;
Infant Care. The Prevention of 15 to 24 months; 2 to 3 years; 3 to
Infantile Diarrhea. 6 years.
Table of Heights and Weights Instructions for North Carolina Midwives.
CONTENTS
Notes and Comment Page 3
State Health Officer Makes Progress Report for 1939.. Page 6
High Point Establishes Clinic Service for the Prevention and Treatment
of Pellagra Page 9
South's Medical Needs Are Cited Page 12
Personal Notes Page 12
Baptist Hospital and Wake Forest Medical School Co-ordinated for Service Page 13
Occupational Disease Hazards Discussed at the Annual Meeting of the
American Institute of Mining and Metallurgical Engineers Page 14
A New Advance on the Health Front Page 14
Appendicitis Deaths Are Preventable Page 15
National Negro Health Week Page 16
1 PUBLI5ALD BY TML. MPR.TM CAgOLIhA 5TATL EPAfg D °^HEiM.TM~]
Vol. 55 MARCH, 1940 No. 3
Notes and Comment
By The
SOMEHOW it seems infinitely fit-ting
that Easter should come early
this year. Coming in this month,
after the most severe winter in North
Carolina and the South thus far ex-perienced
in this century, and a period
of fear and anxiety for people every-where,
it is a welcome reminder of
the sure foundation of spiritual
things. Easter is a symbol of life.
Throughout the State people have
witnessed the destructive forces of
Nature. Forces, cruel and hard to
the poor among humans, and to the
birds and all the creatures of the
wild animal world in particular, as
immortalized in the tales of Uncle
Remus. The Christian world at
least has been shocked every day
throughout this terrible winter at
the refinement of cruelty as prac-ticed
by the Godless Russians, the
arrogant Germans and the Pagan
Japanese, in their cowardly bombing
of helpless women and children, liv-ing
in peace in their defenceless cities
and towns, with no way to defend
themselves. Pestilence and disease
as always in the wake of wanton and
useless war has sent untold thousands
to untimely graves.
In our own State the economic situ-ation
facing us through the destruc-tion
of certain crops and the cur-tailment
of foreign markets is not
pleasant. Those who suffer first and
worst when jobs fail and crops are
damaged and income falls, are the
day-by-day workers and the tenant
Editor
farmers. North Carolina even in
normal times is a State of low per
family and per capita income, mak-ing
the margin between income and
life's actual, bare necessities peril-ously
close at all times for thousands
of families. When the margin is de-ferred
even a little bit, disease
spreads, nutritional deficiencies ap-pear,
a larger percentage of infants
die, and the death rate from pre-ventable
diseases rises and the whole
State suffers in every way.
In 1939, as a result of many fac-tors,
including years of careful and
persistent work, the infant and ma-ternal
death rate in North Carolina
reached the lowest mark ever re-corded
in all the State's history. It
is earnestly hoped that the gains
may be held, but the month of Janu-ary
was bad on the babies in thous-ands
of homes all over the State,
and February is always hard on the
aged and the infants. But as the
bright sunshine and lengthening days
of the Easter season inspire renewed
hope and courage for an afflicted
world, let's all renew our efforts to
make this year's public health record,
even in the face of difficulties, a
better one than last year.
;$: :jc if: ^
One of the grave needs of this
State is more hospitals, an increased
number of beds in those we have,
available to the lower middle-class of
self-respecting people, which comprise
a large part of our population, at
The Health Bulletin March, 19W
a price they can afford to pay. In
a modern community a hospital is as
much a public necessity as a hotel,
a filling station or telephone service.
And before the people rally fully to
the public support of hospitals, they
must be built in their own communi-ties
and be of easy access to them. Just
as the schoolhouse and the church,
the hospital must become a part of
the community. It goes without say-ing
that another need is for a better
distribution of medical care. Both
of these necessities cost money. So
does a graded school with a score of
teachers, and so does an electric
light plant. The people support those
things because they believe in them.
There should be an adequate modern
hospital, with competent medical and
surgical service, certainly in every
county-seat town.
The State Board of Health, less
than two years ago, insisted on
one of the eastern counties that it
join in the organization of a district
health department, a serious need
then and now, the cost to the county
to be less than $2,000 per year. The
; .wyer boss of the county, a potent
member of the Legislature, would not
even let the county board consider
the proposal. "It cost too much
—
the county can't afford it."
Just the other day the newspapers
carried an account of the completion
of a fine new courthouse (lawyer's
club) in that county, costing about
f 100,000. The taxpayers can come
in there and pay their taxes, the
criminals can sit in the fine new
•chairs while being tried. But the dis-eases
rampant in that county will not
:be treated there. Disease prevention
will not be taught its people there,
and it will not in any way ameliorate
the misery of the sick and suffering
among its citizens. A courthouse is
a necessity, but so is a modern health
.department, hospital and medical ser-vice.
Half the interest the county
will have to pay annually on its
courthouse bonds for the next twenty
or thirty years would support an ade-quate
health department. The lawyer
politician, however, cannot (or rather
will not) see it that way.
The hospital insurance system will,
if properly managed and organized,
take care of maintenance of hospitals
in every community.
This writer for one believes that
there is sufficient ability, honesty,
initiative and public spirit inherent in
the medical profession of this State to
provide adequate and competent medi-cal
and surgical service within the
reach of every citizen of the State.
* * * *
Elsewhere in this issue we are
quoting from a newspaper report of
a discussion of the needs of the State
in respect to hospital and medical
service, by Dr. Wilburt C. Davison,
Dean of Duke Medical School, at a
meeting sometime ago. Dr. Davison
is in a better position to discuss
such a subject than any other mem-ber
of the medical profession at this
time. Since Dr. Davison issued his
statement, public announcement has
been made by Wake Forest College
of plans for the establishment of a
four-year medical school at Winston-
Salem. This important move has
been made possible by the family of
the late Mr. Bowman Gray. The be-quest
is to be sufficient to erect the
necessary buildings, with full equip-ment,
and to provide sufficient en-dowment
for partial maintenance. In
connection with the medical school,
the Baptists have already provided
for doubling the capacity of their
excellent hospital at that place. With
the fine record of the Wake Forest
Medical School already established
through the years, the people of the
entire State will be the beneficiaries.
We are publishing in another column
March, 19AO The Health Bulletin
an article by Mr. 0. M. Mull in a
recent issue of the Biblical Recorder
description of the New College plans.
We also present an editorial by Mr.
Santford Martin in the Winston-
Salem Journal and Sentinel on the
same subject.
* * * *
In the meantime, interesting things
are happening in our own particular
sphere, and after all by far the most
important feature of all these needs
and activities under discussion—pre-ventive
medicine. One of the most
encouraging items of this New Year
is a report from Mrs. Wilbur H.
Currie, of the Moore County Ma-ternal
Welfare Committee. Mrs. Cur-rie
reports that there has not been
a maternal death in Moore County
since August, 1938. The organiza-tion
of work in that county for ma-ternal
and infant care and its exe-cution
is such an inspiring story that
we hope and expect to present it
exhaustively in an early issue of the
Health Bulletin.
Another item which the Editor
takes pleasure in passing along is a
letter from a parent of a school
child in Hillsboro. It is nothing new,
but Dr. Branch, of the Oral Hygiene
Division, loves to hear it just the
same. And as the "old-timers" at
least know the Editor, too, is proud
of the record of school dentistry.
Twenty-two years ago he succeeded
in establishing a system of school
dental health service after several
years' study and planning. He stuck
to the project day and night for eight
long years, and with the help of such
great men in the dental profession
as Fleming, Squires, Everett, Jack-son,
Spurgeon, Wheeler, Betts, Hunt
and many others, school dental health
work was established in North Caro-lina
on a sure and permanent founda-tion.
For the past decade the work
has been under the direction of Dr.
Branch, and every citizen of the State
is now familiar with it.
The letter from the Hillsboro par-ent
was accompanied with several
photographs published in the Durham
Sun. The letter follows:
"I am sending a clipping from the
Durham paper, showing what your
dentist sent to our town is doing for
the health of our children. I consider
this very valuable, especially so, since
some of our schools sell too much
candy.
"I'm so thankful that someone
could recognize this, and show by the
use of rats just what the proper diet
means to a child.
"My little girl has gained some
valuable knowledge from this."
"A Parent."
As the month of March is the one
month in the year when more can and
should be done than in any other
month to prevent illness and death
caused by pellagra, we take pleasure
in presenting on another page in this
issue an article by Dr. R. A. Her-ring,
Director of the City Health De-partment
of High Point, describing
a clinical service instituted by His
department in cooperation with the
local Chapter of the American Red
Cross. This clinical service was in-stituted
by Dr. Herring and his as-sociates
last year and his article
describes their experience in the work.
So far as we know, this is the first
instance of the kind in which such
a service has been established in the
State.
The pellagra clinic service described
by Dr. Herring was instituted there
on April 1st last year. So great
was the response, indicating the need,
that it was necessary for the first
two and a half months to have two
clinic sessions a week. After that,
weekly sessions were scheduled until
October 31st.
Dr. Herring was fortunate in hav-
The Health Bulletin March, 1940
ing an able and sympathetic assistant
in the person of Dr. Frederick R.
Taylor, recognized throughout this
section of the South as one of the
most competent authorities on the
subject of pellagra. Dr. Taylor is a
man who has a sympathetic attitude
toward all the problems of public
health. While he is making a living
practicing medicine, he has always
been willing to contribute of his time
to the limit of his capacity in any
required public service which would
advance the interest of the poor peo-ple
in his section and of the health
department work.
We hope that all of the health of-ficers
in the State will read this ar-ticle
of Dr. Herring's with particular
interest, and there is not a doubt but
what a similar service could be easily
organized in several of the other
larger towns in the State. Such a
service should be organized and put
into effect on or soon after the first
of April if it is to be of much value
to the sufferers from pellagra this
spring and summer.
We are greatly indebted to Dr.
Herring for his excellent article, as
well as for his initiative in estab-lishing
the service in High Point.
State Health Officer Makes Progress
Report for 1939
By Carl V. Reynolds, M.
AST year witnessed gains on sev- " eral important fronts in the battle
against disease in North Carolina.
Information that is both interest-ing
and encouraging is found in the
1939 provisional report of the State
Board of Health's Division of Vital
Statistics, of which Dr. R. T. Stimp-son
is the Director. On the other
hand, certain weaknesses also are
revealed. Any report that simply
gives figures, uninterpreted, carries
little weight and is soon forgotten.
We must bear in mind that a year's
compilation is merely factual; that
it can, at best, reflect only a "trend,"
encouraging or discouraging, as the
case may be. To get the true pic-ture,
we must follow the "trend"*
through a series of years.
Vital statistics figures in North
Carolina for last year, which have
just been compiled, do, in some in-stances,
reflect a very decided and
encouraging "trend." The 80,421
births reported during the year out-numbered
the 31,928 deaths that oc-
D., State Health Officer
curred during the same period by
48,493, and there were 1,636 fewer
deaths than were reported the previ-ous
year, bringing the rate down
from 9.5 to 9.0 from 1938 to 1939.
If the 1938 rate had remained un-changed
in 1939, the total number
of deaths would have been 33,839,
instead of 31,928, which means that,
on this basis, the number of lives
saved was, in reality, 1,911, instead
of 1,636. Please bear in mind and
recall in your future reading that an
increase or reduction of one point
represents the saving or loss of 3,500
lives within a year.
Pneumonia—Brighter Picture
Pneumonia has continued through
the years to be one of the greatest
scourges that has harrassed human-ity.
Men and women, physician and
the laity, have bowed helplessly be-fore
its inexorable law of death. But
a new day appears to be at hand in
the battle against this arch-enemy.
While a single year's figures can-not
be taken as final as they apply
March, 19UO The Health Bulletin
to pneumonia any more than in their
application to any other disease, yet
we have here a very striking ex-ample
of an encouraging "trend."
In North Carolina last year we
saved the lives of 537 more pneu-monia
patients from untimely graves
than we did the previous year, the
total number of deaths from this
cause in 1939 having been 2,172, as
compared with 2,709 in 1938, the rate
dropping from 76.8 to 61.0.
To emphasize the downward "trend"
in deaths from pneumonia in North
Carolina, it is pointed out that there
was also a decline from 1937 to
1938, when the number dropped from
2,945 to 2,709, and the rate from
84.3 to 76.8. In other words, the rate
dropped 2.33 points in two years and
the number of pneumonia deaths 773.
Reasons for Decline
We feel that this saving of life has
been due to two major causes: The
early typing of the disease for the
administration of pneumonia serum
and sulfapyridine, which has shown
results nothing short of marvelous.
Technicians for typing pneumonia
may now be found at strategic points
throughout the State, due to the
courses in training which began at
Duke University in January, 1938,
through the cooperation of the Medi-cal
School of that institution and the
North Carolina State Board of Health,
stimulated by the active support of
the North Carolina Commission on
Pneumonia Control, of which Dr.
Hubert B. Haywood, of Raleigh, also
a member of the State Board of
Health, is chairman. There were 67
technicians trained during the first
course at Duke, in addition to those
who had previously qualified and pio-neered
in this great work in our
State.
I wish to emphasize here the value
of Dr. Haywood's interest in this
matter, as he devoted much time to
laying the groundwork for what has
proved to be such a successful under-taking.
While the use of sulfapyridine has
wrought revolutionary changes in the
pneumonia situation and has brought
hope to the victims of a disease which,
as late as 1937, took a toll of 110,000
lives in the United States, the im-portance
of early diagnosis remains
paramount. Neither serum nor sul-fapyridine
can be expected to over-come
the serious handicap that delay
brings.
I cannot leave this subject without
sounding a warning against neglect-ing
what so many people erroneously
term the "common cold" or a "touch
of flu." Every "common cold" or
"touch of flu" should be treated seri-ously
until it proves itself otherwise,
and we should constantly bear in
mind that the "common cold" and
"touch of flu" furnish a fertile
field for the complication—pneumonia,
which remains a serious menace to
life and health.
Saving Babies, Mothers
One of the most gratifying features
of the 1939 report lies in the fact
that it reflects a "trend" which has
now become very definite in North
Carolina—a sharp reduction in both
infant and maternal mortality.
Last year the lives of 757 babies
under a year old were saved, the total
number of deaths in this group hav-ing
been 4,704, as compared with
5,461 in 1938. During a single year
North Carolina's infant mortality
rate dropped from 68.3 to 58.5 per
1,000 live births. The United States
as a whole had an infant mortality
rate of 54.4 in 1937, the last year
for which figures are available, and
it is interesting to note that the
White infant death rate for the en-tire
country that year was 50 and
the Negro rate 82. The White rate
for North Carolina was 56, the Negro
8 The Health Bulletin March, I960
rate 85 and the total rate 64.9. The
average Negro population in the
United States is 10 per cent, as com-pared
with 29 per cent in North Caro-lina.
This gives added importance
to our local figures.
Maternal deaths per 1,000 live births
in North Carolina dropped from 450
in 1938 to 383 in 1939, bringing the
rate down from 5.6 to 4.8 in a single
year. In 1935 the maternal death
rate in North Carolina was 7.0. So,
there was a drop of 2.2 points in four
years. The United States rate in
1937 was 4.9. This means we are
making progress. Stated in simple
terms, North Carolina last year saved
67 mothers and had 518 more live
births than during the preceding year.
These figures are encouraging to
public health workers, because they
show that beneficial results have ac-crued
from the work that is being
done in infant and maternal clinics
and from the other efforts that are
being exerted to save the State's
mothers and babies.
Last year saw the saving of 357
lives of children under two years of
age in North Carolina from death
from diarrhea and enteritis, the rate
falling from 29.2 to 18.9 between
1938 and 1939.
Preventable Diseases
Now, let's take a look at another
aspect of the vital statistics picture
in North Carolina, as painted by
figures for 1939. We will consider
a few of the preventable diseases and
see what we have done in this field.
Typhoid deaths in 1938 numbered 72,
or a rate of 2.0, as compared with 46
and a rate of 1.3 in 1939. This re-flected
an actual saving, not consider-ing
the increased population of 26
lives. Typhoid is a preventable dis-ease
and we have gone a long way
toward its elimination, but the means
of combating it have only to be
abated, even temporarily, for it to
flare up and become the menace it
formerly was.
I want to call particular attention
to deaths from undulant fever. There
were 6 last year, with a rate of 0.2,
as compared with 2 in 1938, with a
rate of 0.06. Only recently, I read
with interest a newspaper article that
had its origin with our State De-partment
of Agriculture calling at-tention
to the problem presented by
Bang's disease—or infectious abor-tion
in cattle, which is a source of
undulant fever, and discussing ways
and means for its elimination. Here
we have both an agricultural and
a health problem, and I am glad to
note that there is a serious effort
being made to eradicate Bang's dis-ease
and, thereby, lessen the "trend"
toward a greater incidence of undu-lant
fever. In this connection I wish
to call the particular attention of
hog and goat breeders to the im-portance
of inoculating these animals
against infectious abortion as a fur-ther
aid in the prevention of the
spread of the undulant fever scourge.
There is at least one State in the
Union where undulant fever is as
great a hazard as typhoid.
The Diphtheria "Disgrace"
Diphtheria, in spite of the fact that
it is preventable, continues to take
its toll among our young. There were
173 deaths from this disease in 1939,
with a rate of 4.9, as compared with
176 deaths and a rate of 5.0 in 1938,
the decrease in both the number of
cases and the rate having been negli-gible.
It is nothing short of a dis-grace
that we should have so many
deaths from this disease. Urgent
appeals have gone forward for the
enforcement of the law which pro-vides
that all babies shall be im-munized
against this disease between
the ages of six months and twelve
months and which provides that no
child shall be admitted to any public,
March, 1940 The Health Bulletin
private or parochial school who has
not been immunized.
The results of this law should have
been apparent before now, as it was
ratified last March. While there may
be no evidence of enforcement up to
the present time, this law must be
complied with!
We are proud of the continuous
progress we have made in our war
on tuberculosis in all forms. Last
year there were in North Carolina
1,657 deaths from pulmonary tuber-culosis,
with a rate of 46.5, as com-pared
with 1,968 deaths and a rate
of 48.1 in 1938—a decrease of 41
deaths and 1.6 in the rate. Other
forms of tuberculosis claimed 149 vic-tims,
as compared with 155 the previ-ous
year, a drop of 6, while the rate
fell from 4.4 to 4.2.
When I sum up the gains that have
been made in our fight against typhoid
fever, infant and maternal mortality,
pneumonia, tuberculosis and other dis-eases
which we can either prevent or
successfully treat and note the com-paratively
slow progress that has
been made against diphtheria, a pre-ventable
disease beyond question, I
feel like crying out: "Mothers, be-ware!"
or, perhaps, "Forgive them,
for they know not what they do in
practicing such neglect!"
A Challenge
The number of people who die vio-lent
deaths in North Carolina each
year presents a distinct challenge.
While many of these do not fall into
the category of public health prob-lems,
strictly speaking, they do have
a very decided bearing on public
safety. We hear a lot about "safety,"
but, alas, like the weather, there
sometimes seems to be little we can
do about it. In many cases, these
violent deaths are preventable. Think
it over.
Last year there were in North Caro-lina
1,494 deaths from what are
styled "preventable accidents," as
compared with 1,444 the preceding
year, a gain of 50. These included:
Automobile accidents, primary, as re-ported
to the State Board of Health,
899; automobile and railroad colli-sions,
28; other railroad accidents, 93;
air transportation accidents, 7; acci-dental
drownings, 154; conflagration
and accidental burns, 246; accidental
traumatism by firearms, 67. There
was a marked increase in drownings,
50 more having been reported than
occurred in 1938, the majority oc-curring,
of course, in the summer
months during the extremely hot
weather.
There was a decrease of 57 in the
number of suicides and an increase
of 3 in homicides.
In presenting these figures, I have
undertaken to do more than to pre-sent
so many "statistics"; I have
tried to give the people something to
think about and hope that I have
succeeded.
High Point Establishes Clinic Service for the
Prevention and Treatment of Pellagra
By R. A. Herring, M. D., City Health Officer
W/ITH the recent isolation and
" identification of nicotinic acid as
the pellagara-preventive factor of
the vitamin B complex, renewed in-terest
has been shown in the field of
prevention and treatment of pellagra
throughout the endemic area of this
disease. The literature in this re-lationship
has been voluminous dur-ing
the past two years, the result of
1(1 The Health Bulletin March, 1940
investigations by the recognized au-thorities
on pellagra. At the present
time this drug occupies the status of a
specific in treatment, since it has shown
the ability to bring about immediate
clearing of the acute symptoms.
When applied in a public health
program, this drug should therefore
be the means of quickly rehabilitat-ing
clinically a large group of per-sons
of low economic status, who, on
account of the incidental dietary de-ficiency,
have had the disease de-velop
and are unable to receive the
medical and other attention neces-sary
to relieve them. Such groups
occur in all urban and rural areas
of the South and may properly be
included among the cliental of the
preventive clinical services of the
public health department of this area.
The following is a brief review of
the experience of such a clinical ser-vice
now being carried on in the
High Point City Health Department.
This activity, constituting as it does
a distinct preventive feature of the
present health department program,
is said to be the first to be estab-lished
in the State. The review is
offered in the hope that additional
similar services may be established
in other health departments, since
unquestionably there exist large num-bers
of pellagrins in close proximity
to most of the city and county health
departments of the State, many of
whom, by reason of their low eco-nomic
status, could properly come
within the benefits of such a service.
The activity was developed in this
health department in cooperation with
the local Chapter of the American
Red Cross. This organization, it may
be recalled, entered the pellagra field a
few years ago as a relief activity and
now renders aid to pellagra cases at
a number of points in the South. The
local Chapter took up this problem
in 1935, furnishing yeast and garden-seed
to indigent cases and early in
1937 had listed over three hundred
cases to whom it had furnished or
was furnishing assistance.
Upon organization of the present
full-time public health program in
High Point early in 1937, the pel-lagra
field became a field of mutual
interest to the Red Cross Chapter
and the City Health Department, and
since that year the two organizations
have given it cooperative attention.
Early in the period since then the
present Director of Health indicated
to the Red Cross Chapter that the
principal deficiency in the Red Cross
pellagra program locally was a lack
of clinical supervision of the cases
to which the Chapter was giving as-sistance,
since it theretofore had had
no means of screening their relief
cases to eliminate the non-pellagrins
and of checking the results of the
preventive work clinically in the in-dividual
cases. A pellagra clinic was
suggested as the means of overcom-ing
this deficiency. The clinical ser-vice
was organized during the cur-rent
year and began operating on
April 1, 1939. During the first two
and a half months of operation, due
to the heavy patient load during its
early stages, clinic sessions were held
twice weekly; thereafter weekly ses-sions
were scheduled and continued
until October 31st, the period of seven
months of operation being the period
of the year of acute symptoms in
clinical cases.
The clinic was located in the City
Health Department, where adequate
facilities for clinical study and phy-sical
examinations of patients are
available. The department provided
a nurse for the clinic sessions, lab-oratory
service, record forms, files
and other needs of the clinic. The
Red Cross Chapter provided a nomi-nal
fee for payment of the clinician,
a social worker for case-finding and
March, 1940 The Health Bulletin 11
follow-up and, in some instances,
transportation of patients to and from
the clinic and supplied the nicotinic
acid and yeast necessary in treatment
of cases. Clinic sessions began at
8:30 A. M. and at times, due to
heavy load, extended to 12:00 noon
on Tuesday of each week. Dr. Fred-erick
R. Taylor, an outstanding au-thority
on this disease, who recently
contributed his second revision of Dr.
Edward Jenner Wood's chapter on
pellagra in Oxford Medicine, served
as clinician. Clinic sessions had an
average of about fifteen patients at
each period. A total of 157 persons,
who made 450 visits to the clinic,
were received for examination dur-ing
the seven months of operation.
Of these 109 were classified definitely
as pellagrins, past or present, and
48 a